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Kamath AM, Schaefer AM, Palmisano EB, Johanns CK, Gonzalez Marmol A, Dinarte Mendoza M, Schwarzbauer K, Zúñiga-Brenes P, Ríos-Zertuche D, Iriarte E, Mokdad AH, Hernandez Prado B. Access and use of oxytocin for postpartum haemorrhage prevention: a pre-post study targeting the poorest in six Mesoamerican countries. BMJ Open 2020; 10:e034084. [PMID: 32184311 PMCID: PMC7076242 DOI: 10.1136/bmjopen-2019-034084] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2019] [Revised: 12/03/2019] [Accepted: 03/03/2020] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES Haemorrhage remains the leading cause of maternal mortality in Central America. The Salud Mesoamérica Initiative aims to reduce such mortality via performance indicators. Our objective was to assess the availability and administration of oxytocin, before and after applying Salud Mesoamérica Initiative interventions in the poorest health facilities across Central America. DESIGN Pre-post study. SETTING 166 basic-level and comprehensive-level health facilities in Belize, Guatemala, Honduras, Mexico, Nicaragua and Panama. PARTICIPANTS A random sample of medical records for uncomplicated full-term deliveries (n=2470) per International Classification of Diseases coding at baseline (July 2011 to August 2013) and at first-phase follow-up (January 2014 to October 2014). INTERVENTIONS A year of intervention implementation prior to first-phase follow-up data collection focused on improving access to oxytocin by strengthening supply chains, procurement, storage practices and pharmacy inventory monitoring, using a results-based financing model. PRIMARY AND SECONDARY OUTCOME MEASURES Oxytocin availability (primary outcome) and administration (secondary outcome) for postpartum haemorrhage prevention. RESULTS Availability of oxytocin increased from 82.9% to 97.6%. Oxytocin administration increased from 83.6% to 88.4%. Significant improvements were seen for availability of oxytocin (adjusted OR (aOR)=8.41, 95% CI 1.50 to 47.30). Administration of oxytocin was found to be significantly higher in Honduras (aOR=2.96; 95% CI 1.00 to 8.76) in reference to Guatemala at follow-up. CONCLUSION After interventions to increase health facility supplies, the study showed a significant improvement in availability but not administration of oxytocin in poor communities within Mesoamerica. Efforts are needed to improve the use of oxytocin.
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Affiliation(s)
- Aruna M Kamath
- Department of Health Metrics Sciences, Institute for Health Metrics and Evaluation, Seattle, Washington, USA
- Department of Anesthesiology and Pain Medicine, University of Washington, Seattle, Washington, USA
| | - Alexandra M Schaefer
- Department of Health Metrics Sciences, Institute for Health Metrics and Evaluation, Seattle, Washington, USA
| | - Erin B Palmisano
- Department of Health Metrics Sciences, Institute for Health Metrics and Evaluation, Seattle, Washington, USA
| | - Casey K Johanns
- Department of Health Metrics Sciences, Institute for Health Metrics and Evaluation, Seattle, Washington, USA
| | | | | | - Karla Schwarzbauer
- Salud Mesoamerica Initiative, Inter-American Development Bank, Tegucigalpa, Honduras
| | - Paola Zúñiga-Brenes
- Salud Mesoamerica Initiative, Inter-American Development Bank, San José, Costa Rica
| | - Diego Ríos-Zertuche
- Salud Mesoamerica Initiative, Inter-American Development Bank, Washington, DC, USA
| | - Emma Iriarte
- Salud Mesoamerica Initiative, Inter-American Development Bank, Panama City, Panama
| | - Ali H Mokdad
- Department of Health Metrics Sciences, Institute for Health Metrics and Evaluation, Seattle, Washington, USA
| | - Bernardo Hernandez Prado
- Department of Health Metrics Sciences, Institute for Health Metrics and Evaluation, Seattle, Washington, USA
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Rios-Zertuche D, Zúñiga-Brenes P, Palmisano E, Hernández B, Schaefer A, Johanns CK, Gonzalez-Marmol A, Mokdad AH, Iriarte E. Methods to measure quality of care and quality indicators through health facility surveys in low- and middle-income countries. Int J Qual Health Care 2019; 31:183-190. [PMID: 29917087 PMCID: PMC6464097 DOI: 10.1093/intqhc/mzy136] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2017] [Revised: 05/02/2018] [Accepted: 05/31/2018] [Indexed: 12/28/2022] Open
Abstract
Objective Present methods to measure standardized, replicable and comparable metrics to measure quality of medical care in low- and middle-income countries. Design We constructed quality indicators for maternal, neonatal and child care. To minimize reviewer judgment, we transformed criteria from check-lists into data points and decisions into conditional algorithms. Distinct criteria were established for each facility level and type of care. Indicators were linked to discharge diagnoses. We designed electronic abstraction tools using computer-assisted personal interviewing software. Setting We present results for data collected in the poorest areas of Belize, Costa Rica, El Salvador, Guatemala, Honduras, Nicaragua, Panama and the state of Chiapas in Mexico (January—October 2014). Results We collected data from 12 662 medical records. Indicators show variations of quality of care between and within countries. Routine interventions, such as quality antenatal care (ANC), immediate neonatal care and postpartum contraception, had low levels of compliance. Records that complied with quality ANC ranged from 68.8% [confidence interval (CI):64.5–72.9] in Costa Rica to 5.7% [CI:4.0–8.0] in Guatemala. Less than 25% of obstetric and neonatal complications were managed according to standards in all countries. Conclusions Our study underscores that, with adequate resources and technical expertise, collecting data for quality indicators at scale in low- and middle-income countries is possible. Our indicators offer a comparable, replicable and standardized framework to identify variations on quality of care. The indicators and methods described are highly transferable and could be used to measure quality of care in other countries.
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Affiliation(s)
- Diego Rios-Zertuche
- Salud Mesoamérica Initiative/Inter-American Development Bank, Calle 50, Edificio Tower Financial Center (Towerbank), Piso 23, Apartado postal: 0816-02900 zona 5, Panamá, Panamá
| | - Paola Zúñiga-Brenes
- Salud Mesoamérica Initiative/Inter-American Development Bank, Calle 50, Edificio Tower Financial Center (Towerbank), Piso 23, Apartado postal: 0816-02900 zona 5, Panamá, Panamá
| | - Erin Palmisano
- Institute for Health Metrics and Evaluation, School of Medicine, University of Washington, 2301 Fifth Ave., Suite 600, Seattle, WA, USA
| | - Bernardo Hernández
- Institute for Health Metrics and Evaluation, School of Medicine, University of Washington, 2301 Fifth Ave., Suite 600, Seattle, WA, USA
| | - Alexandra Schaefer
- Institute for Health Metrics and Evaluation, School of Medicine, University of Washington, 2301 Fifth Ave., Suite 600, Seattle, WA, USA
| | - Casey K Johanns
- Institute for Health Metrics and Evaluation, School of Medicine, University of Washington, 2301 Fifth Ave., Suite 600, Seattle, WA, USA
| | - Alvaro Gonzalez-Marmol
- Salud Mesoamérica Initiative/Inter-American Development Bank, Calle 50, Edificio Tower Financial Center (Towerbank), Piso 23, Apartado postal: 0816-02900 zona 5, Panamá, Panamá
| | - Ali H Mokdad
- Institute for Health Metrics and Evaluation, School of Medicine, University of Washington, 2301 Fifth Ave., Suite 600, Seattle, WA, USA
| | - Emma Iriarte
- Salud Mesoamérica Initiative/Inter-American Development Bank, Calle 50, Edificio Tower Financial Center (Towerbank), Piso 23, Apartado postal: 0816-02900 zona 5, Panamá, Panamá
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McNellan CR, Dansereau E, Wallace MCG, Colombara DV, Palmisano EB, Johanns CK, Schaefer A, Ríos-Zertuche D, Zúñiga-Brenes P, Hernandez B, Iriarte E, Mokdad AH. Antenatal care as a means to increase participation in the continuum of maternal and child healthcare: an analysis of the poorest regions of four Mesoamérican countries. BMC Pregnancy Childbirth 2019; 19:66. [PMID: 30755183 PMCID: PMC6371485 DOI: 10.1186/s12884-019-2207-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2017] [Accepted: 01/28/2019] [Indexed: 11/22/2022] Open
Abstract
Background Antenatal care (ANC) is a means to identify high-risk pregnancies and educate women so that they might experience a healthier delivery and outcome. There is a lack of evidence about whether receipt of ANC is an effective strategy for keeping women in the system so they partake in other maternal and child interventions, particularly for poor women. The present analysis examines whether ANC uptake is associated with other maternal and child health behaviors in poor mothers in Guatemala, Honduras, Nicaragua, and Mexico (Chiapas). Methods We conducted a cross-sectional survey of women regarding their uptake of ANC for their most recent delivery in the last two years and their uptake of selected services and healthy behaviors along a continuity of maternal and child healthcare. We conducted logistic regressions on a sample of 4844 births, controlling for demographic, household, and maternal characteristics to understand the relationship between uptake of ANC and later participation in the continuum of care. Results Uptake of four ANC visits varied by country from 17.0% uptake in Guatemala to 81.4% in Nicaragua. In all countries but Nicaragua, ANC was significantly associated with in-facility delivery (IFD) (Guatemala odds ratio [OR] = 5.28 [95% confidence interval [CI] 3.62–7.69]; Mexico OR = 5.00 [95% CI: 3.41–7.32]; Honduras OR = 2.60 [95% CI: 1.42–4.78]) and postnatal care (Guatemala OR = 4.82 [95% CI: 3.21–7.23]; Mexico OR = 4.02 [95% CI: 2.77–5.82]; Honduras OR = 2.14 [95% CI: 1.26–3.64]), but did not appear to have any positive relationship with exclusive breastfeeding habits or family planning methods, which may be more strongly determined by cultural influences. Conclusions Our results demonstrate that uptake of the WHO-recommended four ANC visits has limited effectiveness on uptake of services in some poor populations in Mesoamérica. Our study highlights the need for continued and varied efforts in these populations to increase both the uptake and the effectiveness of ANC in encouraging positive and lasting effects on women’s uptake of health care services.
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Affiliation(s)
- Claire R McNellan
- Institute for Health Metrics and Evaluation, 2301 5th Ave, Suite, Seattle, WA, 600, USA.
| | - Emily Dansereau
- Institute for Health Metrics and Evaluation, 2301 5th Ave, Suite, Seattle, WA, 600, USA
| | - Marielle C G Wallace
- Institute for Health Metrics and Evaluation, 2301 5th Ave, Suite, Seattle, WA, 600, USA
| | - Danny V Colombara
- Institute for Health Metrics and Evaluation, 2301 5th Ave, Suite, Seattle, WA, 600, USA
| | - Erin B Palmisano
- Institute for Health Metrics and Evaluation, 2301 5th Ave, Suite, Seattle, WA, 600, USA
| | - Casey K Johanns
- Institute for Health Metrics and Evaluation, 2301 5th Ave, Suite, Seattle, WA, 600, USA
| | - Alexandra Schaefer
- Institute for Health Metrics and Evaluation, 2301 5th Ave, Suite, Seattle, WA, 600, USA
| | - Diego Ríos-Zertuche
- Salud Mesoamérica Initiative/Inter-American Development Bank, Calle 50, Edificio Tower Financial Center (Towerbank), Piso 23, Panamá city, Panamá
| | - Paola Zúñiga-Brenes
- Salud Mesoamérica Initiative/Inter-American Development Bank, Calle 50, Edificio Tower Financial Center (Towerbank), Piso 23, Panamá city, Panamá
| | - Bernardo Hernandez
- Institute for Health Metrics and Evaluation, 2301 5th Ave, Suite, Seattle, WA, 600, USA.,University of Washington Department of Health Metrics Sciences and Department of Global Health, 1510 San Juan Rd, Seattle, WA, 98195, USA
| | - Emma Iriarte
- Salud Mesoamérica Initiative/Inter-American Development Bank, Calle 50, Edificio Tower Financial Center (Towerbank), Piso 23, Panamá city, Panamá
| | - Ali H Mokdad
- Institute for Health Metrics and Evaluation, 2301 5th Ave, Suite, Seattle, WA, 600, USA
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4
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El Bcheraoui C, Zúñiga-Brenes P, Ríos-Zertuche D, Palmisano EB, McNellan CR, Desai SS, Gagnier MC, Haakenstad A, Johanns C, Schaefer A, Hernandez B, Iriarte E, Mokdad AH. Health system strategies to increase HIV screening among pregnant women in Mesoamerica. Popul Health Metr 2018; 16:5. [PMID: 29554930 PMCID: PMC5859704 DOI: 10.1186/s12963-018-0162-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2016] [Accepted: 03/02/2018] [Indexed: 12/03/2022] Open
Abstract
Background To propose health system strategies to meeting the World Health Organization (WHO) recommendations on HIV screening through antenatal care (ANC) services, we assessed predictors of HIV screening, and simulated the impact of changes in these predictors on the probability of HIV screening in Guatemala, Honduras, Mexico (State of Chiapas), Nicaragua, Panama, and El Salvador. Methods We interviewed a representative sample of women of reproductive age from the poorest Mesoamerican areas on ANC services, including HIV screening. We used a multivariate logistic regression model to examine correlates of HIV screening. First differences in expected probabilities of HIV screening were simulated for health system correlates that were associated with HIV screening. Results Overall, 40.7% of women were screened for HIV during their last pregnancy through ANC. This rate was highest in El Salvador and lowest in Guatemala. The probability of HIV screening increased with education, household expenditure, the number of ANC visits, and the type of health care attendant of ANC visits. If all women were to be attended by a nurse, or a physician, and were to receive at least four ANC visits, the probability of HIV screening would increase by 12.5% to reach 45.8%. Conclusions To meet WHO’s recommendations for HIV screening, special attention should be given to the poorest and least educated women to ensure health equity and progress toward an HIV-free generation. In parallel, health systems should be strengthened in terms of testing and human resources to ensure that every pregnant woman gets screened for HIV. A 12.5% increase in HIV screening would require a minimum of four ANC visits and an appropriate professional attendance of these visits.
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Affiliation(s)
- Charbel El Bcheraoui
- Institute for Health Metrics and Evaluation, 2301 5th Ave, Suite, Seattle, WA, 600, USA.
| | - Paola Zúñiga-Brenes
- Salud Mesoamérica 2015 / Inter-American Development Bank, Calle 50, Edificio Tower Financial Center (Towerbank), Piso 23, Panamá, Panamá
| | - Diego Ríos-Zertuche
- Salud Mesoamérica 2015 / Inter-American Development Bank, Calle 50, Edificio Tower Financial Center (Towerbank), Piso 23, Panamá, Panamá
| | - Erin B Palmisano
- Institute for Health Metrics and Evaluation, 2301 5th Ave, Suite, Seattle, WA, 600, USA
| | - Claire R McNellan
- Institute for Health Metrics and Evaluation, 2301 5th Ave, Suite, Seattle, WA, 600, USA
| | - Sima S Desai
- Institute for Health Metrics and Evaluation, 2301 5th Ave, Suite, Seattle, WA, 600, USA
| | - Marielle C Gagnier
- Institute for Health Metrics and Evaluation, 2301 5th Ave, Suite, Seattle, WA, 600, USA
| | - Annie Haakenstad
- Institute for Health Metrics and Evaluation, 2301 5th Ave, Suite, Seattle, WA, 600, USA
| | - Casey Johanns
- Institute for Health Metrics and Evaluation, 2301 5th Ave, Suite, Seattle, WA, 600, USA
| | - Alexandra Schaefer
- Institute for Health Metrics and Evaluation, 2301 5th Ave, Suite, Seattle, WA, 600, USA
| | - Bernardo Hernandez
- Institute for Health Metrics and Evaluation, 2301 5th Ave, Suite, Seattle, WA, 600, USA
| | - Emma Iriarte
- Salud Mesoamérica 2015 / Inter-American Development Bank, Calle 50, Edificio Tower Financial Center (Towerbank), Piso 23, Panamá, Panamá
| | - Ali H Mokdad
- Institute for Health Metrics and Evaluation, 2301 5th Ave, Suite, Seattle, WA, 600, USA
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5
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Hernandez B, Colombara DV, Gagnier MC, Desai SS, Haakenstad A, Johanns C, McNellan CR, Nelson J, Palmisano EB, Ríos-Zertuche D, Schaefer A, Zúñiga-Brenes P, Iriarte E, Mokdad AH. Barriers and facilitators for institutional delivery among poor Mesoamerican women: a cross-sectional study. Health Policy Plan 2017; 32:769-780. [PMID: 28335004 DOI: 10.1093/heapol/czx010] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/20/2017] [Indexed: 11/13/2022] Open
Abstract
Professional skilled care has shown to be one of the most promising strategies to reduce maternal mortality, and in-facility deliveries are a cost-effective way to ensure safe births. Countries in Mesoamerica have emphasized in-facility delivery care by professionally skilled attendants, but access to good-quality delivery care is still lacking for many women. We examined the characteristics of women who had a delivery in a health facility and determinants of the decision to bypass a closer facility and travel to a distant one. We used baseline information from the Salud Mesoamerica Initiative (SMI). Data were collected from a large household and facilities sample in the poorest quintile of the population in Guatemala, Honduras and Nicaragua. The analysis included 1592 deliveries. After controlling for characteristics of women and health facilities, being primiparous (RR = 1.15, 95% CI 1.10, 1.21), being literate (RR = 1.24, 95% CI 1.04, 1.48), having antenatal care (RR = 1.68, 95% CI 1.24, 2.27), being informed of the need for having a C-section (RR = 1.07, 95% CI 1.02, 1.11) and travel time to the closest facility totaling 1-2 h vs under 30 min (RR = 0.88, 95% CI 0.77, 0.99) were associated with in-health facility deliveries. In Guatemala, increased availability of medications and equipment at a distant facility was strongly associated with bypassing the closest facility in favor of a distant one for delivery (RR = 2.10, 95% CI 1.08, 4.07). Our study showed a strong correlation between well-equipped facilities and delivery attendance in poor areas of Mesoamerica. Indeed, women were more likely to travel to more distant facilities if the facilities were of higher level, which scored higher on our capacity score. Our findings call for improving the capacity of health facilities, quality of care and addressing cultural and accessibility barriers to increase institutional delivery among the poor population in Mesoamerica.
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Affiliation(s)
- Bernardo Hernandez
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - Danny V Colombara
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - Marielle C Gagnier
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - Sima S Desai
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - Annie Haakenstad
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, MA, USA and
| | - Casey Johanns
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - Claire R McNellan
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - Jennifer Nelson
- Salud Mesoamerica Initiative/Inter-American Development Bank, Panama, Panama
| | - Erin B Palmisano
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - Diego Ríos-Zertuche
- Salud Mesoamerica Initiative/Inter-American Development Bank, Panama, Panama
| | - Alexandra Schaefer
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - Paola Zúñiga-Brenes
- Salud Mesoamerica Initiative/Inter-American Development Bank, Panama, Panama
| | - Emma Iriarte
- Salud Mesoamerica Initiative/Inter-American Development Bank, Panama, Panama
| | - Ali H Mokdad
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
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McNellan C, Dansereau E, Colombara D, Palmisano E, Wallace M, Johanns C, Schaefer A, Ríos-Zertuche D, Zúñiga-Brenes P, Hernandez B, Iriarte E, Mokdad A. Uptake of Antenatal Care, and its Relationship with Participation in
Health Services and Behaviors: An Analysis of the Poorest Regions of Four
Mesoamerican Countries. Ann Glob Health 2017. [DOI: 10.1016/j.aogh.2017.03.482] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
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7
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Rios-Zertuche D, Blanco LC, Zúñiga-Brenes P, Palmisano EB, Colombara DV, Mokdad AH, Iriarte E. Contraceptive knowledge and use among women living in the poorest areas of five Mesoamerican countries. Contraception 2017; 95:549-557. [PMID: 28126542 PMCID: PMC5493184 DOI: 10.1016/j.contraception.2017.01.005] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2016] [Revised: 01/13/2017] [Accepted: 01/16/2017] [Indexed: 11/18/2022]
Abstract
Objective To identify factors associated with contraceptive use among women in need living in the poorest areas in five Mesoamerican countries: Guatemala, Honduras, Nicaragua, Panama and State of Chiapas (Mexico). Study design We analyzed baseline data of 7049 women of childbearing age (15–49 years old) collected for the Salud Mesoamérica Initiative. Data collection took place in the 20% poorest municipalities of each country (July, 2012-August, 2013). Results Women in the poorest areas were very poorly informed about family planning methods. Concern about side effects was the main reason for nonuse. Contraceptive use was lower among the extremely poor (<$1.25 USD PPP per day) [odds ratio (OR): 0.75; confidence interval (CI): 0.59–0.96], those living more than 30 min away from a health facility (OR 0.71, CI: 0.58–0.86), and those of indigenous ethnicity (OR 0.50, CI: 0.39–0.64). Women who were insured and visited a health facility also had higher odds of using contraceptives than insured women who did not visit a health facility (OR 1.64, CI: 1.13–2.36). Conclusions Our study showed low use of contraceptives in poor areas in Mesoamerica. We found the urgent need to improve services for people of indigenous ethnicity, low education, extreme poverty, the uninsured, and adolescents. It is necessary to address missed opportunities and offer contraceptives to all women who visit health facilities. Governments should aim to increase the public's knowledge of long-acting reversible contraception and offer a wider range of methods to increase contraceptive use. Implications We show that unmet need for contraception is higher among the poorest and describe factors associated with low use. Our results call for increased investments in programs and policies targeting the poor to decrease their unmet need.
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Affiliation(s)
- Diego Rios-Zertuche
- Salud Mesoamérica Initiative/Inter-American Development Bank, Calle 50, Edificio Tower Financial Center (Towerbank), Piso 23, Panama, Panama.
| | | | - Paola Zúñiga-Brenes
- Salud Mesoamérica Initiative/Inter-American Development Bank, Calle 50, Edificio Tower Financial Center (Towerbank), Piso 23, Panama, Panama.
| | - Erin B Palmisano
- Institute for Health Metrics and Evaluation, 2301 5th Ave, Suite 600, Seattle, WA, USA.
| | - Danny V Colombara
- Institute for Health Metrics and Evaluation, 2301 5th Ave, Suite 600, Seattle, WA, USA.
| | - Ali H Mokdad
- Institute for Health Metrics and Evaluation, 2301 5th Ave, Suite 600, Seattle, WA, USA.
| | - Emma Iriarte
- Salud Mesoamérica Initiative/Inter-American Development Bank, Calle 50, Edificio Tower Financial Center (Towerbank), Piso 23, Panama, Panama.
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Rios-Zertuche D, Cuchilla J, Zúñiga-Brenes P, Hernández B, Jara P, Mokdad AH, Iriarte E. Alcohol abuse and other factors associated with risky sexual behaviors among adolescent students from the poorest areas in Costa Rica. Int J Public Health 2016; 62:271-282. [PMID: 27572491 DOI: 10.1007/s00038-016-0859-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2016] [Revised: 06/07/2016] [Accepted: 07/08/2016] [Indexed: 10/21/2022] Open
Abstract
OBJECTIVES We applied the Integrative Model of Behavioral Prediction to analyze factors associated with risky sexual behaviors for adolescent students living in the poorest segments in Costa Rica. METHODS We used data from a school-based knowledge, attitudes, and behaviors survey from the poorest districts of Costa Rica, collected for Salud Mesoamerica Initiative. We analyzed responses of 919 male and female students (12-19 years old) to determine factors associated with sexual intercourse and condom use. RESULTS One of every four students reported being sexually active. Students that reported being sexually active were more likely to consume excessive alcohol (OR 3.04 [95 % CI 1.94-4.79]). While 88.0 % [95 % CI 73.5-95.1] of sexually active adolescents said they would use a condom the next time they have sex, only 53.1 % [95 % CI 39.3-66.5] reported condom use the last time. Non-condom-users felt purchasing condoms was uncomfortable (OR 0.34 [95 % CI 0.12-0.93]). CONCLUSIONS Poor adolescents in Costa Rica begin sexual activities early and undertake behaviors that increase their risk for unwanted pregnancies and sexually transmitted infections. We found the urgent need to address alcohol abuse, and recognize gender differences in youth health programs.
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Affiliation(s)
- Diego Rios-Zertuche
- Salud Mesoamérica Initiative/Inter-American Development Bank, Panama City, Panama.
| | | | - Paola Zúñiga-Brenes
- Salud Mesoamérica Initiative/Inter-American Development Bank, Panama City, Panama
| | - Bernardo Hernández
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, USA
| | | | - Ali H Mokdad
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, USA
| | - Emma Iriarte
- Salud Mesoamérica Initiative/Inter-American Development Bank, Panama City, Panama
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Dansereau E, McNellan CR, Gagnier MC, Desai SS, Haakenstad A, Johanns CK, Palmisano EB, Ríos-Zertuche D, Schaefer A, Zúñiga-Brenes P, Hernandez B, Iriarte E, Mokdad AH. Coverage and timing of antenatal care among poor women in 6 Mesoamerican countries. BMC Pregnancy Childbirth 2016; 16:234. [PMID: 27542909 PMCID: PMC4991111 DOI: 10.1186/s12884-016-1018-5] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2015] [Accepted: 08/08/2016] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Poor women in the developing world have a heightened need for antenatal care (ANC) but are often the least likely to attend it. This study examines factors associated with the number and timing of ANC visits for poor women in Guatemala, Honduras, Mexico, Nicaragua, Panama, and El Salvador. METHODS We surveyed 8366 women regarding the ANC they attended for their most recent birth in the past two years. We conducted logistic regressions to examine demographic, household, and health characteristics associated with attending at least one skilled ANC visit, four skilled visits, and a skilled visit in the first trimester. RESULTS Across countries, 78 % of women attended at least one skilled ANC visit, 62 % attended at least four skilled visits, and 56 % attended a skilled visit in the first trimester. The proportion of women attending four skilled visits was highest in Nicaragua (81 %) and lowest in Guatemala (18 %) and Panama (38 %). In multiple countries, women who were unmarried, less-educated, adolescent, indigenous, had not wanted to conceive, and lacked media exposure were less likely to meet international ANC guidelines. In countries with health insurance programs, coverage was associated with attending skilled ANC, but not the timeliness. CONCLUSIONS Despite significant policy reforms and initiatives targeting the poor, many women living in the poorest regions of Mesoamérica are not meeting ANC guidelines. Both supply and demand interventions are needed to prioritize vulnerable groups, reduce unplanned pregnancies, and reach populations not exposed to common forms of media. Top performing municipalities can inform effective practices across the region.
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Affiliation(s)
- Emily Dansereau
- Institute for Health Metrics and Evaluation, 2301 5th Ave, Suite 600, Seattle, WA USA
| | - Claire R. McNellan
- Institute for Health Metrics and Evaluation, 2301 5th Ave, Suite 600, Seattle, WA USA
| | - Marielle C. Gagnier
- Institute for Health Metrics and Evaluation, 2301 5th Ave, Suite 600, Seattle, WA USA
| | - Sima S. Desai
- Institute for Health Metrics and Evaluation, 2301 5th Ave, Suite 600, Seattle, WA USA
| | - Annie Haakenstad
- Harvard School of Public Health, 677 Huntington Ave., Boston, MA USA
| | - Casey K. Johanns
- Institute for Health Metrics and Evaluation, 2301 5th Ave, Suite 600, Seattle, WA USA
| | - Erin B. Palmisano
- Institute for Health Metrics and Evaluation, 2301 5th Ave, Suite 600, Seattle, WA USA
| | - Diego Ríos-Zertuche
- Salud Mesoamérica Initiative/Inter-American Development Bank, Calle 50, Edificio Tower Financial Center (Towerbank), Piso 23, Panamá, Panamá
| | - Alexandra Schaefer
- Institute for Health Metrics and Evaluation, 2301 5th Ave, Suite 600, Seattle, WA USA
| | - Paola Zúñiga-Brenes
- Salud Mesoamérica Initiative/Inter-American Development Bank, Calle 50, Edificio Tower Financial Center (Towerbank), Piso 23, Panamá, Panamá
| | - Bernardo Hernandez
- Institute for Health Metrics and Evaluation, 2301 5th Ave, Suite 600, Seattle, WA USA
| | - Emma Iriarte
- Salud Mesoamérica Initiative/Inter-American Development Bank, Calle 50, Edificio Tower Financial Center (Towerbank), Piso 23, Panamá, Panamá
| | - Ali H. Mokdad
- Institute for Health Metrics and Evaluation, 2301 5th Ave, Suite 600, Seattle, WA USA
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10
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Colombara DV, Hernández B, Schaefer A, Zyznieuski N, Bryant MF, Desai SS, Gagnier MC, Johanns CK, McNellan CR, Palmisano EB, Ríos-Zertuche D, Zúñiga-Brenes P, Iriarte E, Mokdad AH. Institutional Delivery and Satisfaction among Indigenous and Poor Women in Guatemala, Mexico, and Panama. PLoS One 2016; 11:e0154388. [PMID: 27120070 PMCID: PMC4847770 DOI: 10.1371/journal.pone.0154388] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2016] [Accepted: 04/12/2016] [Indexed: 11/23/2022] Open
Abstract
Indigenous women in Mesoamerica experience disproportionately high maternal mortality rates and are less likely to have institutional deliveries. Identifying correlates of institutional delivery, and satisfaction with institutional deliveries, may help improve facility utilization and health outcomes in this population. We used baseline surveys from the Salud Mesoamérica Initiative to analyze data from 10,895 indigenous and non-indigenous women in Guatemala and Mexico (Chiapas State) and indigenous women in Panama. We created multivariable Poisson regression models for indigenous (Guatemala, Mexico, Panama) and non-indigenous (Guatemala, Mexico) women to identify correlates of institutional delivery and satisfaction. Compared to their non-indigenous peers, indigenous women were substantially less likely to have an institutional delivery (15.2% vs. 41.5% in Guatemala (P<0.001), 29.1% vs. 73.9% in Mexico (P<0.001), and 70.3% among indigenous Panamanian women). Indigenous women who had at least one antenatal care visit were more than 90% more likely to have an institutional delivery (adjusted risk ratio (aRR) = 1.94, 95% confidence interval (CI): 1.44-2.61), compared to those who had no visits. Indigenous women who were advised to give birth in a health facility (aRR = 1.46, 95% CI: 1.18-1.81), primiparous (aRR = 1.44, 95% CI: 1.24-1.68), informed that she should have a Caesarean section (aRR = 1.41, 95% CI: 1.21-1.63), and had a secondary or higher level of education (aRR = 1.36, 95% CI: 1.04-1.79) also had substantially higher likelihoods of institutional delivery. Satisfaction among indigenous women was associated with being able to be accompanied by a community health worker (aRR = 1.15, 95% CI: 1.05-1.26) and facility staff speaking an indigenous language (aRR = 1.10, 95% CI: 1.02-1.19). Additional effort should be exerted to increase utilization of birthing facilities by indigenous and poor women in the region. Improving access to antenatal care and opportunities for higher-level education may increase institutional delivery rates, and providing culturally adapted services may improve satisfaction.
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Affiliation(s)
- Danny V. Colombara
- Institute for Health Metrics and Evaluation, 2301 5th Ave, Suite 600, Seattle, Washington, United States of America
| | - Bernardo Hernández
- Institute for Health Metrics and Evaluation, 2301 5th Ave, Suite 600, Seattle, Washington, United States of America
| | - Alexandra Schaefer
- Institute for Health Metrics and Evaluation, 2301 5th Ave, Suite 600, Seattle, Washington, United States of America
| | - Nicholas Zyznieuski
- Institute for Health Metrics and Evaluation, 2301 5th Ave, Suite 600, Seattle, Washington, United States of America
| | - Miranda F. Bryant
- Institute for Health Metrics and Evaluation, 2301 5th Ave, Suite 600, Seattle, Washington, United States of America
| | - Sima S. Desai
- Institute for Health Metrics and Evaluation, 2301 5th Ave, Suite 600, Seattle, Washington, United States of America
| | - Marielle C. Gagnier
- Institute for Health Metrics and Evaluation, 2301 5th Ave, Suite 600, Seattle, Washington, United States of America
| | - Casey K. Johanns
- Institute for Health Metrics and Evaluation, 2301 5th Ave, Suite 600, Seattle, Washington, United States of America
| | - Claire R. McNellan
- Institute for Health Metrics and Evaluation, 2301 5th Ave, Suite 600, Seattle, Washington, United States of America
| | - Erin B. Palmisano
- Institute for Health Metrics and Evaluation, 2301 5th Ave, Suite 600, Seattle, Washington, United States of America
| | - Diego Ríos-Zertuche
- Salud Mesoamérica Initiative, Inter-American Development Bank, Calle 50 con Calle Elvira Méndez, Edificio Tower Financial Center (Towerbank), Piso 23, Panamá City, Panamá
| | - Paola Zúñiga-Brenes
- Salud Mesoamérica Initiative, Inter-American Development Bank, Calle 50 con Calle Elvira Méndez, Edificio Tower Financial Center (Towerbank), Piso 23, Panamá City, Panamá
| | - Emma Iriarte
- Salud Mesoamérica Initiative, Inter-American Development Bank, Calle 50 con Calle Elvira Méndez, Edificio Tower Financial Center (Towerbank), Piso 23, Panamá City, Panamá
| | - Ali H. Mokdad
- Institute for Health Metrics and Evaluation, 2301 5th Ave, Suite 600, Seattle, Washington, United States of America
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11
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Colombara DV, Hernández B, McNellan CR, Desai SS, Gagnier MC, Haakenstad A, Johanns C, Palmisano EB, Ríos-Zertuche D, Schaefer A, Zúñiga-Brenes P, Zyznieuski N, Iriarte E, Mokdad AH. Diarrhea Prevalence, Care, and Risk Factors Among Poor Children Under 5 Years of Age in Mesoamerica. Am J Trop Med Hyg 2016; 94:544-52. [PMID: 26787152 DOI: 10.4269/ajtmh.15-0750] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2015] [Accepted: 11/30/2015] [Indexed: 11/07/2022] Open
Abstract
Care practices and risk factors for diarrhea among impoverished communities across Mesoamerica are unknown. Using Salud Mesoamérica Initiative baseline data, collected 2011-2013, we assessed the prevalence of diarrhea, adherence to evidence-based treatment guidelines, and potential diarrhea correlates in poor and indigenous communities across Mesoamerica. This study surveyed 14,500 children under 5 years of age in poor areas of El Salvador, Guatemala, Mexico (Chiapas State), Nicaragua, and Panama. We compared diarrhea prevalence and treatment modalities using χ(2) tests and used multivariable Poisson regression models to calculate adjusted risk ratios (aRRs) and 95% confidence intervals (CIs) for potential correlates of diarrhea. The 2-week point prevalence of diarrhea was 13% overall, with significant differences between countries (P < 0.05). Approximately one-third of diarrheal children were given oral rehydration solution and less than 3% were given zinc. Approximately 18% were given much less to drink than usual or nothing to drink at all. Antimotility medication was given to 17% of diarrheal children, while antibiotics were inappropriately given to 36%. In a multivariable regression model, compared with children 0-5 months, those 6-23 months had a 49% increased risk for diarrhea (aRR = 1.49, 95% CI = 1.15, 1.95). Our results call for programs to examine and remedy low adherence to evidence-based treatment guidelines.
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Affiliation(s)
- Danny V Colombara
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, Washington; Salud Mesoamérica Initiative, Inter-American Development Bank, Panamá, Panamá
| | - Bernardo Hernández
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, Washington; Salud Mesoamérica Initiative, Inter-American Development Bank, Panamá, Panamá
| | - Claire R McNellan
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, Washington; Salud Mesoamérica Initiative, Inter-American Development Bank, Panamá, Panamá
| | - Sima S Desai
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, Washington; Salud Mesoamérica Initiative, Inter-American Development Bank, Panamá, Panamá
| | - Marielle C Gagnier
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, Washington; Salud Mesoamérica Initiative, Inter-American Development Bank, Panamá, Panamá
| | - Annie Haakenstad
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, Washington; Salud Mesoamérica Initiative, Inter-American Development Bank, Panamá, Panamá
| | - Casey Johanns
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, Washington; Salud Mesoamérica Initiative, Inter-American Development Bank, Panamá, Panamá
| | - Erin B Palmisano
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, Washington; Salud Mesoamérica Initiative, Inter-American Development Bank, Panamá, Panamá
| | - Diego Ríos-Zertuche
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, Washington; Salud Mesoamérica Initiative, Inter-American Development Bank, Panamá, Panamá
| | - Alexandra Schaefer
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, Washington; Salud Mesoamérica Initiative, Inter-American Development Bank, Panamá, Panamá
| | - Paola Zúñiga-Brenes
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, Washington; Salud Mesoamérica Initiative, Inter-American Development Bank, Panamá, Panamá
| | - Nicholas Zyznieuski
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, Washington; Salud Mesoamérica Initiative, Inter-American Development Bank, Panamá, Panamá
| | - Emma Iriarte
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, Washington; Salud Mesoamérica Initiative, Inter-American Development Bank, Panamá, Panamá
| | - Ali H Mokdad
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, Washington; Salud Mesoamérica Initiative, Inter-American Development Bank, Panamá, Panamá
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12
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Mokdad AH, Gagnier MC, Colson KE, Dansereau E, Zúñiga-Brenes P, Ríos-Zertuche D, Haakenstad A, Johanns CK, Palmisano EB, Hernandez B, Iriarte E. Missed Opportunities for Measles, Mumps, and Rubella (MMR) Immunization in Mesoamerica: Potential Impact on Coverage and Days at Risk. PLoS One 2015; 10:e0139680. [PMID: 26506563 PMCID: PMC4624243 DOI: 10.1371/journal.pone.0139680] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2015] [Accepted: 09/16/2015] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND Recent outbreaks of measles in the Americas have received news and popular attention, noting the importance of vaccination to population health. To estimate the potential increase in immunization coverage and reduction in days at risk if every opportunity to vaccinate a child was used, we analyzed vaccination histories of children 11-59 months of age from large household surveys in Mesoamerica. METHODS Our study included 22,234 children aged less than 59 months in El Salvador, Guatemala, Honduras, Mexico, Nicaragua, and Panama. Child vaccination cards were used to calculate coverage of measles, mumps, and rubella (MMR) and to compute the number of days lived at risk. A child had a missed opportunity for vaccination if their card indicated a visit for vaccinations at which the child was not caught up to schedule for MMR. A Cox proportional hazards model was used to compute the hazard ratio associated with the reduction in days at risk, accounting for missed opportunities. RESULTS El Salvador had the highest proportion of children with a vaccine card (91.2%) while Nicaragua had the lowest (76.5%). Card MMR coverage ranged from 44.6% in Mexico to 79.6% in Honduras while potential coverage accounting for missed opportunities ranged from 70.8% in Nicaragua to 96.4% in El Salvador. Younger children were less likely to have a missed opportunity. In Panama, children from households with higher expenditure were more likely to have a missed opportunity for MMR vaccination compared to the poorest (OR 1.62, 95% CI: 1.06-2.47). In Nicaragua, compared to children of mothers with no education, children of mothers with primary education and secondary education were less likely to have a missed opportunity (OR 0.46, 95% CI: 0.24-0.88 and OR 0.25, 95% CI: 0.096-0.65, respectively). Mean days at risk for MMR ranged from 158 in Panama to 483 in Mexico while potential days at risk ranged from 92 in Panama to 239 in El Salvador. CONCLUSIONS Our study found high levels of missed opportunities for immunizing children in Mesoamerica. Our findings cause great concern, as they indicate that families are bringing their children to health facilities, but these children are not receiving all appropriate vaccinations during visits. This points to serious problems in current immunization practices and protocols in poor areas in Mesoamerica. Our study calls for programs to ensure that vaccines are available and that health professionals use every opportunity to vaccinate a child.
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Affiliation(s)
- Ali H. Mokdad
- Institute for Health Metrics and Evaluation, 2301 5th Ave, Suite 600, Seattle, Washington, United States of America
| | - Marielle C. Gagnier
- Institute for Health Metrics and Evaluation, 2301 5th Ave, Suite 600, Seattle, Washington, United States of America
| | - K. Ellicott Colson
- Division of Epidemiology, School of Public Health, University of California Berkeley, Berkeley, California, United States of America
| | - Emily Dansereau
- Institute for Health Metrics and Evaluation, 2301 5th Ave, Suite 600, Seattle, Washington, United States of America
| | - Paola Zúñiga-Brenes
- Salud Mesoamérica 2015 / Inter-American Development Bank, Calle 50, Edificio Tower Financial Center (Towerbank), Piso 23, Panamá, Panamá
| | - Diego Ríos-Zertuche
- Salud Mesoamérica 2015 / Inter-American Development Bank, Calle 50, Edificio Tower Financial Center (Towerbank), Piso 23, Panamá, Panamá
| | - Annie Haakenstad
- Institute for Health Metrics and Evaluation, 2301 5th Ave, Suite 600, Seattle, Washington, United States of America
| | - Casey K. Johanns
- Institute for Health Metrics and Evaluation, 2301 5th Ave, Suite 600, Seattle, Washington, United States of America
| | - Erin B. Palmisano
- Institute for Health Metrics and Evaluation, 2301 5th Ave, Suite 600, Seattle, Washington, United States of America
| | - Bernardo Hernandez
- Institute for Health Metrics and Evaluation, 2301 5th Ave, Suite 600, Seattle, Washington, United States of America
| | - Emma Iriarte
- Salud Mesoamérica 2015 / Inter-American Development Bank, Calle 50, Edificio Tower Financial Center (Towerbank), Piso 23, Panamá, Panamá
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13
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Colombara DV, Hernández B, Gagnier MC, Johanns C, Desai SS, Haakenstad A, McNellan CR, Palmisano EB, Ríos-Zertuche D, Schaefer A, Zúñiga-Brenes P, Zyznieuski N, Iriarte E, Mokdad AH. Breastfeeding Practices among Poor Women in Mesoamerica. J Nutr 2015; 145:1958-65. [PMID: 26136592 DOI: 10.3945/jn.115.213736] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2015] [Accepted: 06/08/2015] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Breastfeeding is an effective intervention to reduce pediatric morbidity and mortality. The prevalence of practices and predictors of breastfeeding among the poor in Mesoamerica has not been well described. OBJECTIVES We estimated the prevalence of ever breastfeeding, early initiation of breastfeeding, exclusive breastfeeding, and breastfeeding between 6 mo and 2 y of age using household survey data for the poorest quintile of families living in 6 Mesoamerican countries. We also assessed the predictors of breastfeeding behaviors to identify factors amenable to policy interventions. METHODS We analyzed data from 12,529 children in Guatemala, Honduras, Mexico (Chiapas State), Nicaragua, Panama, and El Salvador using baseline survey data from the Salud Mesoamérica 2015 Initiative. We created multivariable Poisson regression models with robust variance estimates to calculate adjusted risk ratios (aRRs) and 95% CIs for breastfeeding outcomes and to control for sociodemographic and healthcare-related factors. RESULTS Approximately 97% of women in all countries breastfed their child at least once, and 65.1% (Nicaragua) to 79.0% (Panama) continued to do so between 6 mo and 2 y of age. Breastfeeding in the first hour of life varied by country (P < 0.001), with the highest proportion reported in Panama (89.8%) and the lowest in El Salvador (65.6%). Exclusive breastfeeding also varied by country (P = 0.037), ranging from 44.5% in Panama to 76.8% in Guatemala. For every 20% increase in the proportion of peers who exclusively breastfed, there was an 11% (aRR: 1.11, 95% CI: 1.04, 1.18) increase in the likelihood of exclusive breastfeeding. CONCLUSION Our study revealed significant variation in the prevalence of breastfeeding practices by poor women across countries surveyed by the Salud Mesoamérica 2015 initiative. Future interventions to promote exclusive breastfeeding should consider ways to leverage the role of the community in supporting individual women.
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Affiliation(s)
| | | | | | - Casey Johanns
- Institute for Health Metrics and Evaluation, Seattle, WA; and
| | - Sima S Desai
- Institute for Health Metrics and Evaluation, Seattle, WA; and
| | | | | | | | - Diego Ríos-Zertuche
- Salud Mesoamérica 2015, Inter-American Development Bank, Panama City, Panama
| | | | - Paola Zúñiga-Brenes
- Salud Mesoamérica 2015, Inter-American Development Bank, Panama City, Panama
| | | | - Emma Iriarte
- Salud Mesoamérica 2015, Inter-American Development Bank, Panama City, Panama
| | - Ali H Mokdad
- Institute for Health Metrics and Evaluation, Seattle, WA; and
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14
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Mokdad AH, Gagnier MC, Colson KE, Zúñiga-Brenes P, Ríos-Zertuche D, Haakenstad A, Palmisano EB, Anderson BW, Desai SS, Gillespie CW, Murphy T, Naghavi P, Nelson J, Ranganathan D, Schaefer A, Usmanova G, Wilson S, Hernandez B, Lozano R, Iriarte E. Health and wealth in Mesoamerica: findings from Salud Mesomérica 2015. BMC Med 2015; 13:164. [PMID: 26170012 PMCID: PMC4501100 DOI: 10.1186/s12916-015-0393-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2015] [Accepted: 06/04/2015] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Individual income and poverty are associated with poor health outcomes. The poor face unique challenges related to access, education, financial capacity, environmental effects, and other factors that threaten their health outcomes. METHODS We examined the variation in the health outcomes and health behaviors among the poorest quintile in eight countries of Mesoamerica using data from the Salud Mesomérica 2015 baseline household surveys. We used multivariable logistic regression to measure the association between delivering a child in a health facility and select household and maternal characteristics, including education and measures of wealth. RESULTS Health indicators varied greatly between geographic segments. Controlling for other demographic characteristics, women with at least secondary education were more likely to have an in-facility delivery compared to women who had not attended school (OR: 3.20, 95 % confidence interval [CI]: 2.56-3.99, respectively). Similarly, women from households with the highest expenditure were more likely to deliver in a health facility compared to those from the lowest expenditure households (OR 3.06, 95 % CI: 2.43-3.85). Household assets did not impact these associations. Moreover, we found that commonly-used definitions of poverty do not align with the disparities in health outcomes observed in these communities. CONCLUSIONS Although poverty measured by expenditure or wealth is associated with health disparities or health outcomes, a composite indicator of health poverty based on coverage is more likely to focus attention on health problems and solutions. Our findings call for the public health community to define poverty by health coverage measures rather than income or wealth. Such a health-poverty metric is more likely to generate attention and mobilize targeted action by the health communities than our current definition of poverty.
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Affiliation(s)
- Ali H Mokdad
- Institute for Health Metrics and Evaluation, 2301 5th Ave, Suite 600, Seattle, WA, USA.
| | - Marielle C Gagnier
- Institute for Health Metrics and Evaluation, 2301 5th Ave, Suite 600, Seattle, WA, USA.
| | - K Ellicott Colson
- Division of Epidemiology, School of Public Health, University of California, Berkeley, California.
| | - Paola Zúñiga-Brenes
- Salud Mesoamérica 2015 / Inter-American Development Bank, Calle 50, Edificio Tower Financial Center (Towerbank), Piso 23, Panamá, Panamá.
| | - Diego Ríos-Zertuche
- Salud Mesoamérica 2015 / Inter-American Development Bank, Calle 50, Edificio Tower Financial Center (Towerbank), Piso 23, Panamá, Panamá.
| | - Annie Haakenstad
- Institute for Health Metrics and Evaluation, 2301 5th Ave, Suite 600, Seattle, WA, USA.
| | - Erin B Palmisano
- Institute for Health Metrics and Evaluation, 2301 5th Ave, Suite 600, Seattle, WA, USA.
| | - Brent W Anderson
- Pardee RAND Graduate School, 1776 Main Street, Santa Monica, California, 90401, USA.
| | - Sima S Desai
- Institute for Health Metrics and Evaluation, 2301 5th Ave, Suite 600, Seattle, WA, USA.
| | | | - Tasha Murphy
- University of Washington School of Social Work, 4101 15th Avenue N, Seattle, WA, USA.
| | - Paria Naghavi
- Institute for Health Metrics and Evaluation, 2301 5th Ave, Suite 600, Seattle, WA, USA.
| | - Jennifer Nelson
- Salud Mesoamérica 2015 / Inter-American Development Bank, Calle 50, Edificio Tower Financial Center (Towerbank), Piso 23, Panamá, Panamá.
| | - Dharani Ranganathan
- George Washington University, 950 New Hampshire Ave, NW, Washington, DC, USA.
| | - Alexandra Schaefer
- Institute for Health Metrics and Evaluation, 2301 5th Ave, Suite 600, Seattle, WA, USA.
| | - Gulnoza Usmanova
- Institute for Health Metrics and Evaluation, 2301 5th Ave, Suite 600, Seattle, WA, USA.
| | - Shelley Wilson
- Institute for Health Metrics and Evaluation, 2301 5th Ave, Suite 600, Seattle, WA, USA.
| | - Bernardo Hernandez
- Institute for Health Metrics and Evaluation, 2301 5th Ave, Suite 600, Seattle, WA, USA.
| | - Rafael Lozano
- Institute for Health Metrics and Evaluation, 2301 5th Ave, Suite 600, Seattle, WA, USA.
| | - Emma Iriarte
- Salud Mesoamérica 2015 / Inter-American Development Bank, Calle 50, Edificio Tower Financial Center (Towerbank), Piso 23, Panamá, Panamá.
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15
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Colson KE, Zúñiga-Brenes P, Ríos-Zertuche D, Conde-Glez CJ, Gagnier MC, Palmisano E, Ranganathan D, Usmanova G, Salvatierra B, Nazar A, Tristao I, Sanchez Monin E, Anderson BW, Haakenstad A, Murphy T, Lim S, Hernandez B, Lozano R, Iriarte E, Mokdad AH. Comparative Estimates of Crude and Effective Coverage of Measles Immunization in Low-Resource Settings: Findings from Salud Mesoamérica 2015. PLoS One 2015; 10:e0130697. [PMID: 26136239 PMCID: PMC4489764 DOI: 10.1371/journal.pone.0130697] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2014] [Accepted: 05/23/2015] [Indexed: 01/28/2023] Open
Abstract
Timely and accurate measurement of population protection against measles is critical for decision-making and prevention of outbreaks. However, little is known about how survey-based estimates of immunization (crude coverage) compare to the seroprevalence of antibodies (effective coverage), particularly in low-resource settings. In poor areas of Mexico and Nicaragua, we used household surveys to gather information on measles immunization from child health cards and caregiver recall. We also collected dried blood spots (DBS) from children aged 12 to 23 months to compare crude and effective coverage of measles immunization. We used survey-weighted logistic regression to identify individual, maternal, household, community, and health facility characteristics that predict gaps between crude coverage and effective coverage. We found that crude coverage was significantly higher than effective coverage (83% versus 68% in Mexico; 85% versus 50% in Nicaragua). A large proportion of children (19% in Mexico; 43% in Nicaragua) had health card documentation of measles immunization but lacked antibodies. These discrepancies varied from 0% to 100% across municipalities in each country. In multivariate analyses, card-positive children in Mexico were more likely to lack antibodies if they resided in urban areas or the jurisdiction of De Los Llanos. In contrast, card-positive children in Nicaragua were more likely to lack antibodies if they resided in rural areas or the North Atlantic region, had low weight-for-age, or attended health facilities with a greater number of refrigerators. Findings highlight that reliance on child health cards to measure population protection against measles is unwise. We call for the evaluation of immunization programs using serological methods, especially in poor areas where the cold chain is likely to be compromised. Identification of within-country variation in effective coverage of measles immunization will allow researchers and public health professionals to address challenges in current immunization programs.
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Affiliation(s)
- K. Ellicott Colson
- Division of Epidemiology, University of California, Berkeley, California, United States of America
| | | | | | | | - Marielle C. Gagnier
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, Washington, United States of America
| | - Erin Palmisano
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, Washington, United States of America
| | - Dharani Ranganathan
- George Washington University, Washington, District of Columbia, United States of America
| | - Gulnoza Usmanova
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, Washington, United States of America
| | - Benito Salvatierra
- El Colegio de la Frontera Sur-Mexico, San Cristóbal de Las Casas, Chiapas, Mexico
| | - Austreberta Nazar
- El Colegio de la Frontera Sur-Mexico, San Cristóbal de Las Casas, Chiapas, Mexico
| | - Ignez Tristao
- Salud Mesoamérica 2015/Inter-American Development Bank, Panama City, Panama
| | | | - Brent W. Anderson
- County of Napa Health and Human Services, Department of Public Health, Napa, California, United States of America
| | - Annie Haakenstad
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, Washington, United States of America
| | - Tasha Murphy
- School of Social Work, University of Washington, Seattle, Washington, United States of America
| | - Stephen Lim
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, Washington, United States of America
| | - Bernardo Hernandez
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, Washington, United States of America
| | - Rafael Lozano
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, Washington, United States of America
- Instituto Nacional de Salud Pública, Cuernavaca, Mexico
| | - Emma Iriarte
- Salud Mesoamérica 2015/Inter-American Development Bank, Panama City, Panama
- * E-mail: (EI); (AHM)
| | - Ali H. Mokdad
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, Washington, United States of America
- * E-mail: (EI); (AHM)
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16
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Colson K, Potter A, Conde-Glez C, Hernandez B, Ríos-Zertuche D, Zúñiga-Brenes P, Collaborators SM, Iriarte E, Mokdad AH. Use of a commercial ELISA for the detection of measles-specific immunoglobulin G (IgG) in dried blood spots collected from children living in low-resource settings. J Med Virol 2015; 87:1491-9. [DOI: 10.1002/jmv.24136] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2014] [Revised: 11/26/2014] [Accepted: 11/28/2014] [Indexed: 01/22/2023]
Affiliation(s)
- K.Ellicott Colson
- Institute for Health Metrics and Evaluation at the University of Washington; Seattle Washington USA
| | - Alan Potter
- Department of Laboratory Medicine; University of Washington; Seattle Washington USA
| | | | - Bernardo Hernandez
- Institute for Health Metrics and Evaluation at the University of Washington; Seattle Washington USA
| | | | | | - SM Collaborators
- Institute for Health Metrics and Evaluation at the University of Washington; Seattle Washington USA
- Instituto Nacional de Salud Pública; Cuernavaca México
- El Colegio de la Frontera Sur-Mexico; San Cristóbal de Las Casas; México
- El Centro de Investigación y Estudios en Salud de la Universidad Nacional Autónoma de Nicaragua; Managua Nicaragua
| | - Emma Iriarte
- Salud Mesoamérica/Inter-American Development Bank; Panama City Panama
| | - Ali H. Mokdad
- Institute for Health Metrics and Evaluation at the University of Washington; Seattle Washington USA
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