ABSTRACT
OBJECTIVE: To systematically review and analyze various ways that health systems frameworks interact with the social determinants of health (SDH), as well as the implications of these interactions. METHODS: This was a review of the literature conducted in 2012 using predetermined criteria to search three comprehensive databases (PubMed, the Cochrane Database for Systematic Reviews, and the World Bank E-Library) and grey literature for articles with any consideration of the SDH within health systems frameworks. Snowball sampling and expert opinion were used to include any potentially relevant articles not identified by the initial search. In total, 4 152 documents were found; of these, 27 were included in the analyses. RESULTS: Five main categories of interaction between health systems and SDH emerged: Bounded, Production, Reciprocal, Joint, and Systems models. At one end were the Bounded and Production models, which conceive the SDH to be outside the health system; at the other end, the Joint and Systems models, which visualize a continuous and dynamic interaction. CONCLUSIONS: Considering the complex and dynamic interactions among different kinds of organizations involved in and with the health system,the Joint and Systems models seem to best reflect these interactions, and should thereby guide stakeholders in planning for change.
OBJETIVO: Examinar y analizar sistemáticamente las diversas maneras en que los marcos de los sistemas de salud abordan las interacciones con los determinantes sociales de la salud (DSS), así como las implicaciones de estas interacciones. MÉTODOS: En el 2012, se llevó a cabo una revisión de la bibliografía mediante la adopción de criterios predeterminados para consultar tres bases de datos integrales (PubMed, la Base de Datos Cochrane de Revisiones Sistemáticas y la Biblioteca electrónica del Banco Mundial) y la bibliografía gris, en busca de artículos que incluyeran cualquier tipo de consideración de los DSS en los marcos de los sistemas de salud. Se utilizó el muestreo de bola de nieve y la opinión de expertos con objeto de incluir cualquier artículo potencialmente pertinente no detectado en la búsqueda inicial. En total, se encontraron 4 152 documentos; de estos, 27 se incluyeron en el análisis. RESULTADOS: Se observaron cinco categorías o modelos principales de interacción entre los sistemas de salud y los DSS: Vinculado, de Producción, Recíproco, Conjunto y de Sistemas. En un extremo se situaban los modelos Vinculado y de Producción, que contemplan los DSS como externos al sistema de salud; en el otro extremo, los modelos Conjunto y de Sistemas, que conciben una interacción continua y dinámica entre ellos. CONCLUSIONES: Si se tienen en cuentas las complejas y dinámicas interacciones entre los diferentes tipos de organizaciones involucradas en y con el sistema de salud, los modelos Conjunto y de Sistemas parecen reflejar mejor estas interacciones y, en consecuencia, son los que deberían guiar a los interesados directos en la planificación de los cambios.
Subject(s)
Humans , Delivery of Health Care , Health Services/statistics & numerical data , Models, Theoretical , Social Determinants of Health , Systems Integration , Americas , Community-Institutional Relations , Health Care Sector/organization & administration , Health Services Administration , Public Policy , Qualitative Research , Social EnvironmentABSTRACT
This study retrospectively analyzed demographic factors that may affect the prevalence of intestinal parasites among Guatemalan school children. The findings of the study showed that young age, wet season, female gender, and severe malnutrition all correlated positively with increased rates of infection. Clinical visits were performed on 10,586 school children aged 5-15 years over a four-year period (2004-2007) in the Palajunoj Valley of Guatemala, during which 5,705 viable stool samples were screened for infection with the following parasites: Ascaris lumbricoides, Giardia lamblia, Entamoeba histolytica, Hymenolepis nana, and Blastocystis hominis. The average overall prevalences of infection for specific parasites were A. lumbricoides 17.7%, E. histolytica 16.1%, G. lamblia 10.9%, H. nana 5.4%, and B. hominis 2.8%. Statistical analysis showed significantly higher rates of infection among younger children with G. lamblia (odds ratio [OR]=0.905, 95% confidence interval [CI] 0.871-0.941, p<0.0001) and E. histolytica (p=0.0006), greater prevalence of H. nana among females (OR=1.275, CI 1.010-1.609, p=0.0412), higher infection rates during the wet season for E. histolytica (p=0.0003) and H. nana (OR=0.734, CI 0.557-0.966, p=0.0275), and greater rates of infection with G. lamblia among malnourished children (for moderately malnourished children OR=1.498, CI 1.143-1.963, p<0.0001) and E. histolytica (for mildly malnourished children OR=1.243, CI 1.062-1.455, p=0.0313). The results suggest that the prevalence of gastrointestinal parasites among young Guatemalan children is highly dependent on the specific species of the parasite.