Persistent inequities in maternal mortality in Latin America and the Caribbean, 1990-2019.

BACKGROUND: Despite the resources and personnel mobilized in Latin America and the Caribbean to reduce the maternal mortality ratio (MMR, maternal deaths per 100 000 live births) in women aged 10-54 years by 75% between 2000 and 2015, the region failed to meet the Millenium Development Goals (MDGs) due to persistent barriers to access quality reproductive, maternal, and neonatal health services. METHODS: Using 1990-2019 data from the Global Burden of Disease project, we carried out a two-stepwise analysis to (a) identify the differences in the MMR temporal patterns and (b) assess its relationship with selected indicators: government health expenditure (GHE), the GHE as percentage of gross domestic product (GDP), the availability of human resources for health (HRH), the coverage of effective interventions to reduce maternal mortality, and the level of economic development of each country. FINDINGS: In the descriptive analysis, we observed a heterogeneous overall reduction of MMR in the region between 1990 and 2019 and heterogeneous overall increases in the GHE, GHE/GDP, and HRH availability. The correlation analysis showed a close, negative, and dependent association of the economic development level between the MMR and GHE per capita, the percentage of GHE to GDP, the availability of HRH, and the coverage of SBA. We observed the lowest MMRs when GHE as a percentage of GDP was close to 3% or about US$400 GHE per capita, HRH availability of 6 doctors, nurses, and midwives per 1,000 inhabitants, and skilled birth attendance levels above 90%. CONCLUSIONS: Within the framework of the Sustainable Development Goals (SDGs) agenda, health policies aimed at the effective reduction of maternal mortality should consider allocating more resources as a necessary but not sufficient condition to achieve the goals and should prioritize the implementation of new forms of care with a gender and rights approach, as well as strengthening actions focused on vulnerable groups.

The impact of ever breastfeeding on children ages 12 to 36 months: A secondary data analysis of the standardization study of the Dominican system for evaluating early childhood development.

Extensive research has shown that breastfeeding offers many benefits to children, including advantages in lifelong health, physical development, cognitive function, behavior, and brain development, compared to those not breastfed. In the Dominican Republic, the prevalence of exclusive breastfeeding among infants aged 0-6 months remains low, and the lack of a surveillance system has made it challenging to measure the impact of breastfeeding on early childhood development (ECD). This study aims to address the effect of ever breastfeeding on ECD. We conducted secondary data analysis from the Dominican System for Measuring Early Childhood Development (SIMEDID), a screening tool adapted and validated to the Dominican context that measures four areas of development: gross-motor, fine-motor, language, and socioemotional development. The data from SIMEDID can be cross-analyzed with other datasets generated by the National Institute for Early Childhood Comprehensive Care (INAIPI) that include information about breastfeeding. The children were evaluated during the standardization study of SIMEDID. To determine the breastfeeding impact, we: 1) conducted an analysis of covariance using ECD scores as dependent variables and ever breastfed as the independent variable, with age and sex as covariates (previously confirmed with an analysis of variance indicating the relevance of age and sex at birth in ECD); 2) analyzed the relative risk (RR) of developmental delay by breastfeeding status. We studied a sample of 699 Dominican children aged 12-36 months who receive services at INAIPI (the government institution responsible for administering comprehensive early childhood services). The results show that ever breastfed children had higher scores in overall ECD than those who were not; higher scores in language and fine motor development primarily drove this effect. The never breastfed group had a greater risk of developmental delay in fine motor and socioemotional development. These findings underscore the importance of promoting and supporting breastfeeding to improve child neurodevelopmental outcomes. This is particularly relevant in low-resource settings, where mothers may need additional support. Moreover, the study's results provide evidence of SIMEDID's validation, which can help inform future research and evidence-based decision-making toward optimal ECD in similar contexts.

Achieving and Maintaining Equitable Health Outcomes for all, Including for Future Generations.

Sustainable health equity means achieving and maintaining equitable health outcomes for all people, including for future generations. It encompasses realizing the right to health, setting the conditions for leading a healthy life, and fulfilling the full range of human rights. Achieving sustainable health equity requires that public services be designed and provided, and public policies be developed through empowering, inclusive, participatory, accountable, and democratic processes and mechanisms.

Self-perceived health of older adults in Latin America and the Caribbean: a scoping review.

Objective: To systematically map the existing evidence on self-perceived health among adults aged 60 and older in Latin America and the Caribbean, describe the use of the single-item measure of self-perceived health with this population, and identify gaps in the existing literature. Methods: Following PRISMA Extension for Scoping Reviews guidelines, eight databases were searched for publications that were published between 2009 and 2019 and reported self-perceived health of adults over 60 years old in Latin America and the Caribbean. Data on study characteristics, sample characteristics, and the use and analysis of the self-perceived health measure were charted. Results: The database and secondary searches identified 516 articles. After removing duplicates and assessing titles and abstracts for inclusion, 263 full-text articles were assessed for eligibility using the inclusion criteria and an additional 89 articles were excluded. Ultimately, 174 articles were included in the scoping review. Studies included participants from 17 countries in the region, led in frequency by Brazil with 120 articles. The self-perceived health question most often included a five-category response scale (130), and response options were predominantly divided into two (86) or three (48) categories for analysis. Conclusions: Information on the health and social needs of people aged 60 and older across Latin America and the Caribbean, particularly their perceptions of health, is limited. We highlight the need to expand research throughout the region, include particularly vulnerable populations, utilize data from longitudinal and qualitative studies, and call for transparency in how questions and responses are worded and analyzed. This review serves to inform future studies, programs, and policies directed at this population.

Self-perceived health of older adults in Latin America and the Caribbean: a scoping review

[ABSTRACT]. Objective. To systematically map the existing evidence on self-perceived health among adults aged 60 and older in Latin America and the Caribbean, describe the use of the single-item measure of self-perceived health with this population, and identify gaps in the existing literature. Methods. Following PRISMA Extension for Scoping Reviews guidelines, eight databases were searched for publications that were published between 2009 and 2019 and reported self-perceived health of adults over 60 years old in Latin America and the Caribbean. Data on study characteristics, sample characteristics, and the use and analysis of the self-perceived health measure were charted. Results. The database and secondary searches identified 516 articles. After removing duplicates and assess- ing titles and abstracts for inclusion, 263 full-text articles were assessed for eligibility using the inclusion criteria and an additional 89 articles were excluded. Ultimately, 174 articles were included in the scoping review. Studies included participants from 17 countries in the region, led in frequency by Brazil with 120 articles. The self-perceived health question most often included a five-category response scale (130), and response options were predominantly divided into two (86) or three (48) categories for analysis. Conclusions. Information on the health and social needs of people aged 60 and older across Latin America and the Caribbean, particularly their perceptions of health, is limited. We highlight the need to expand research throughout the region, include particularly vulnerable populations, utilize data from longitudinal and qualitative studies, and call for transparency in how questions and responses are worded and analyzed. This review serves to inform future studies, programs, and policies directed at this population.

[RESUMEN]. Objetivo. Realizar una búsqueda sistemática de la evidencia sobre la autopercepción de la salud en las personas mayores de 60 años en América Latina y el Caribe, describir el uso de la medición basada en un solo ítem para dicha autopercepción en este grupo poblacional y detectar posibles lagunas en la bibliografía existente. Métodos. Se realizaron búsquedas en ocho bases de datos de publicaciones aparecidas entre el 2009 y el 2019 sobre la autopercepción de la salud por las personas mayores de 60 años en América Latina y el Caribe. Las búsquedas se realizaron de conformidad con la guía de la extensión PRISMA para revisiones explorato- rias. Se graficaron los datos sobre las características del estudio, las características de la muestra y el uso y análisis de la medición de autopercepción de la salud. Resultados. Las búsquedas en las bases de datos y las secundarias permitieron localizar 516 artículos. Tras eliminar los duplicados y examinar los títulos y resúmenes para su inclusión, se utilizaron los criterios de inclusión para evaluar la admisibilidad de 263 artículos completos y se excluyeron otros 89 artículos. A fin de cuentas, quedaron seleccionados 174 artículos para la revisión exploratoria. Los estudios incluían participantes de 17 países de la región, con Brasil como el país con el mayor número (120 artículos). Lo más frecuente fue que la pregunta sobre autopercepción en materia de salud incluyera una escala de respuesta de cinco categorías (130), y las opciones de respuesta se dividían predominantemente en dos (86) o tres (48) categorías para su análisis. Conclusiones. La información sobre las necesidades sociales y de salud de las personas mayores de 60 años en América Latina y el Caribe, en particular sus percepciones sobre la propia salud, es limitada. Los autores destacan la necesidad de ampliar la investigación en toda la región, abarcar a los grupos pobla- cionales especialmente vulnerables, utilizar datos de estudios longitudinales y cualitativos y exhortar a la transparencia sobre la manera en que se formulan las preguntas y respuestas. Esta revisión sirve como fun- damento para futuros estudios, programas y políticas orientados a este grupo poblacional.

[RESUMO]. Objetivo. Mapear de forma sistemática as evidências existentes sobre a autopercepção de saúde em pes- soas com 60 anos ou mais na América Latina e no Caribe, descrever o uso de uma medida de item único da autopercepção de saúde nessa população e identificar lacunas na literatura existente. Métodos. Em conformidade com as diretrizes da extensão da ferramenta PRISMA para revisões de escopo, oito bancos de dados foram pesquisados em busca de trabalhos publicados entre 2009 e 2019 que relat- assem a autopercepção de saúde de pessoas com mais de 60 anos de idade na América Latina e no Caribe. Foram tabulados dados sobre as características do estudo, as características da amostra e o uso e a análise da medida de autopercepção de saúde. Resultados. As buscas nos bancos de dados e secundárias identificaram 516 artigos. Depois de descartar artigos repetidos e avaliar títulos e resumos para inclusão, 263 artigos completos foram avaliados quanto à elegibilidade usando os critérios de inclusão, o que levou à exclusão de mais 89 artigos. Por fim, 174 artigos foram incluídos na revisão de escopo. Os estudos incluíam participantes de 17 países da região, e o Brasil foi o país com o maior número de publicações: 120 artigos. A pergunta sobre a autopercepção de saúde incluía, na maioria das vezes, uma escala de resposta com cinco categorias (130), e as opções de resposta foram predominantemente divididas em duas (86) ou três (48) categorias para análise. Conclusões. As informações sobre as necessidades sociais e de saúde das pessoas com 60 anos ou mais na América Latina e no Caribe, especialmente suas percepções de saúde, são limitadas. Destacamos a necessidade de expandir a pesquisa em toda a região, incluir populações particularmente vulneráveis, uti- lizar dados de estudos longitudinais e qualitativos e solicitar transparência na forma como as perguntas e respostas são formuladas e analisadas. Esta análise serve de guia para futuros estudos, programas e políti- cas voltados para essa população.

Health care access and migration experiences among Venezuelan female sex workers living in the Dominican Republic.

Objective: To identify sexual risk behaviors and barriers to sexual and reproductive health care (SRH) among Venezuelan female sex workers living in the Dominican Republic. Methods: This was a mixed-methods study using four focus group discussions (FGDs) and a cross-sectional quantitative survey with Venezuelan migrant female sex workers. The study was conducted from September through October 2021 in two urban areas (Santo Domingo and Puerto Plata) in the Dominican Republic. Information collected from the FGDs was analyzed using thematic content analysis, and quantitative data were analyzed using univariate descriptive statistics. Data analysis was conducted from 30 November 2021 to 20 February 2022. Results: In all, 40 Venezuelan migrant female sex workers with a median (range) age of 33 (19-49) years participated in the FGDs and survey. The FDGs identified barriers to SRH services, including immigration status and its implications for formal employment and health access, mental wellbeing, quality-of-life in the Dominican Republic, navigating sex work, perceptions of sex work, SRH knowledge, and limited social support. Findings of the quantitative analysis indicated that most participants reported feeling depressed (78%), lonely/isolated (75%), and having difficulty sleeping (88%). Participants reported an average of 10 sexual partners in the past 30 days; 55% had engaged in sexual practices while under the influence of alcohol; and only 39% had used a condom when performing oral sex in the past 30 days. Regarding AIDS/HIV, 79% had taken an HIV test in the past 6 months, and 74% knew where to seek HIV services. Conclusions: This mixed-methods study found that nationality and social exclusion have a multilayered influence on migrant female sex workers, sexual risk behaviors, and access to health care. Recommendations for effective evidence-based interventions to address sexual health knowledge need to be implemented to address risky sexual behaviors, improve access to SRH, and reduce affordability barriers.

Health care access and migration experiences among Venezuelan female sex workers living in the Dominican Republic

[ABSTRACT]. Objective. To identify sexual risk behaviors and barriers to sexual and reproductive health care (SRH) among Venezuelan female sex workers living in the Dominican Republic. Methods. This was a mixed-methods study using four focus group discussions (FGDs) and a cross-sectional quantitative survey with Venezuelan migrant female sex workers. The study was conducted from September through October 2021 in two urban areas (Santo Domingo and Puerto Plata) in the Dominican Republic. Infor- mation collected from the FGDs was analyzed using thematic content analysis, and quantitative data were analyzed using univariate descriptive statistics. Data analysis was conducted from 30 November 2021 to 20 February 2022. Results. In all, 40 Venezuelan migrant female sex workers with a median (range) age of 33 (19-49) years par- ticipated in the FGDs and survey. The FDGs identified barriers to SRH services, including immigration status and its implications for formal employment and health access, mental wellbeing, quality-of-life in the Domin- ican Republic, navigating sex work, perceptions of sex work, SRH knowledge, and limited social support. Findings of the quantitative analysis indicated that most participants reported feeling depressed (78%), lonely/ isolated (75%), and having difficulty sleeping (88%). Participants reported an average of 10 sexual partners in the past 30 days; 55% had engaged in sexual practices while under the influence of alcohol; and only 39% had used a condom when performing oral sex in the past 30 days. Regarding AIDS/HIV, 79% had taken an HIV test in the past 6 months, and 74% knew where to seek HIV services. Conclusions. This mixed-methods study found that nationality and social exclusion have a multilayered influ- ence on migrant female sex workers, sexual risk behaviors, and access to health care. Recommendations for effective evidence-based interventions to address sexual health knowledge need to be implemented to address risky sexual behaviors, improve access to SRH, and reduce affordability barriers.

[RESUMEN]. Objetivo. Determinar los comportamientos sexuales de riesgo y los obstáculos para acceder a los servi- cios de salud sexual y reproductiva (SSR) en trabajadoras sexuales venezolanas residentes en República Dominicana. Métodos: En este estudio se empleó una metodología mixta con cuatro debates en grupos de opinión y una encuesta cuantitativa transversal en trabajadoras sexuales migrantes venezolanas. El estudio se llevó a cabo entre septiembre y octubre del 2021 en dos zonas urbanas (Puerto Plata y Santo Domingo) de República Dominicana. La información recopilada a partir de los grupos de opinión se analizó mediante análisis de contenido temático, y los datos cuantitativos se analizaron mediante estadísticas descriptivas univariadas. El análisis de los datos se realizó del 30 de noviembre del 2021 al 20 de febrero del 2022. Resultados: Un total de 40 trabajadoras sexuales migrantes venezolanas con una mediana (rango) de edad de 33 años (entre 19 y 49) participaron en los grupos de opinión y la encuesta. Los grupos de opinión per- mitieron determinar los obstáculos para acceder a los servicios de SSR, como la situación migratoria y sus implicaciones para el acceso al empleo formal y a los servicios de salud, el bienestar mental, la calidad de vida en República Dominicana, el trabajo sexual y la manera de transitarlo, las percepciones sobre el trabajo sexual, los conocimientos sobre la SSR y el escaso apoyo social. Los resultados del análisis cuantitativo indi- caron que la mayoría de las participantes manifestaron que se sentían deprimidas (78%), solas o aisladas (75%), y que tenían dificultades para dormir (88%). Las participantes también indicaron que habían tenido un promedio de 10 parejas sexuales en los últimos 30 días, el 55% había mantenido relaciones sexuales bajo los efectos del alcohol y solo el 39% había utilizado preservativo al practicar sexo oral en los últimos 30 días. En cuanto a la infección por el VIH/sida, el 79% se había sometido a una prueba del VIH en los últimos 6 meses y el 74% sabía dónde buscar servicios relacionados con el VIH. Conclusiones. En este estudio basado en metodologías mixtas, se observó que la nacionalidad y la exclusión social afectan de diversas formas a las trabajadoras sexuales inmigrantes, sus comportamientos sexuales de riesgo y su acceso a la atención de salud. Es necesario poner en práctica las recomendaciones para la realización de intervenciones eficaces basadas en la evidencia para atender los conocimientos sobre salud sexual con el fin de abordar los comportamientos sexuales de riesgo, mejorar el acceso a la SSR y reducir los obstáculos relacionados con la asequibilidad.

[RESUMO]. Objetivo. Identificar comportamentos sexuais de risco e barreiras aos cuidados de saúde sexual e reprodu- tiva (SSR) entre trabalhadoras do sexo venezuelanas que vivem na República Dominicana. Métodos. Estudo de métodos mistos. Foram realizadas quatro discussões com grupos focais e uma pesquisa quantitativa transversal com trabalhadoras do sexo migrantes venezuelanas. O estudo foi realizado de setem- bro a outubro de 2021 em dois áreas urbanas (Santo Domingo e Puerto Plata) da República Dominicana. As informações coletadas dos grupos focais foram analisadas por meio de análise temática de conteúdo, e os dados quantitativos foram analisados por meio de estatísticas descritivas univariadas. A análise dos dados foi realizada de 30 de novembro de 2021 a 20 de fevereiro de 2022. Resultados. No total, 40 trabalhadoras do sexo migrantes venezuelanas, com mediana de idade de 33 anos (mínimo, 19; máximo, 49), participaram dos grupos focais e da pesquisa. Os grupos focais identificaram barreiras aos serviços de SSR, incluindo status de imigração e suas repercussões para o emprego formal e o acesso à saúde, bem-estar mental, qualidade de vida na República Dominicana, navegação do trabalho sexual, percepções do trabalho sexual, conhecimento de SSR e apoio social limitado. Conforme a análise quantitativa, a maioria das participantes relatou sentir-se deprimida (78%), solitária/isolada (75%) e com difi- culdade para dormir (88%). As participantes relataram uma média de 10 parceiros sexuais nos últimos 30 dias; 55% praticaram sexo sob efeito de álcool; e apenas 39% usaram preservativo na prática de sexo oral nos últimos 30 dias. Em relação ao HIV/aids, 79% fizeram teste de HIV nos últimos 6 meses e 74% sabiam onde procurar serviços de HIV. Conclusões. Este estudo de métodos mistos constatou que a nacionalidade e a exclusão social têm uma influência multifacetada nas trabalhadoras do sexo migrantes, nos comportamentos sexuais de risco e no acesso à atenção à saúde. É preciso implementar recomendações para intervenções eficazes e baseadas em evidências para abordar o conhecimento da saúde sexual, visando a abordar comportamentos sexuais de risco, melhorar o acesso aos serviços de SSR e reduzir as barreiras de acessibilidade.

The Dynamics of Intimate Partner Violence and Its Impact on HIV Care: A Cross-Sectional Study of People of Mixed Gender and Sexual Preference in Lima, Peru.

Intimate partner violence (IPV) is associated with a higher risk of contracting HIV and developing worse HIV outcomes. This cross-sectional, mixed methods study presents data on IPV using the Conflicts Tactics Scale (CTS2-S) among 180 persons with HIV in Lima, Peru, as well as qualitative interviews with 7 of them and 18 of their community caregivers. This study used data collected for a randomized controlled trial (RCT), CASAommunity Based Accompaniment with Supervised Antiretrovirals (CASA) Community-based Accompaniment with Supervised Antiretrovirals (CASA). Physical or sexual IPV was self-reported in 82 (45.6%) of participants reporting having been in a relationship in the last year and 59,8% of those were involved in bidirectional violence. Coping subscales, social support, and stigma were associated with IPV. Intimate partner violence negatively impacted patient adherence to medication and care, particularly during times of severe conflict. In conclusion, profound psychosocial vulnerability-including low social support, substance use as coping, and HIV stigma-contextualize IPV among people with HIV. Bidirectional violence often evolved over time as victims negotiated inter-personal strategies for survival, including retaliation. Interventions should focus on a deeper understanding IPV and facilitating of coping mechanisms to help people with HIV stay in care.

Validation of the Dominican system for measuring early childhood development.

Background: The purpose of the study was to determine the psychometric properties of the Dominican System for Measuring Early Childhood Development (SIMEDID, for its Spanish acronym), to adjust the sequence of item presentation, and to provide age-standardized norms for each item, to enable policy and program managers to make decisions based on specific and structured data. Methods: After approval from an ethics committee, a total of 948 children from 0 to 60 months participated in this study. Participants were evaluated on four early childhood development domains (gross motor, fine motor, language development, and socio-emotional development). The data were collected from November 2021 to February 2022, either at early childhood care centers or at home, using mobile devices that guided the evaluators through the screener. Data were later synced to a global database. Psychometric properties were calculated using Cronbach's alpha and split-half parallel reliability. For reorganizing item presentation and to obtain age-standardized norms, we conducted a logistic regression analysis for each item on dependent variable item success, and independent variable age. Results: The instrument showed excellent reliability and additional evidence of validity. The item presentation order was rearranged according to the probability of item success progression. In addition, the study characterized the expected evolution of item success probability across participants' age. Conclusions: SIMEDID is a valid and reliable instrument for depicting childhood development in national evaluations. Its integration with electronic platforms for national monitoring represents a cost-effective, time-efficient screening tool adapted to the Dominican sociocultural context. This represents a promising tool to strengthen strategies that support early childhood development.

Health care access and migration experiences among Venezuelan female sex workers living in the Dominican Republic / Experiencias en materia de migración y acceso a la atención de salud en trabajadoras sexuales venezolanas residentes en República Dominicana / Acesso à atenção à saúde e experiências de migração entre trabalhadoras do sexo venezuelanas que vivem na República Dominicana

ABSTRACT Objective. To identify sexual risk behaviors and barriers to sexual and reproductive health care (SRH) among Venezuelan female sex workers living in the Dominican Republic. Methods. This was a mixed-methods study using four focus group discussions (FGDs) and a cross-sectional quantitative survey with Venezuelan migrant female sex workers. The study was conducted from September through October 2021 in two urban areas (Santo Domingo and Puerto Plata) in the Dominican Republic. Information collected from the FGDs was analyzed using thematic content analysis, and quantitative data were analyzed using univariate descriptive statistics. Data analysis was conducted from 30 November 2021 to 20 February 2022. Results. In all, 40 Venezuelan migrant female sex workers with a median (range) age of 33 (19-49) years participated in the FGDs and survey. The FDGs identified barriers to SRH services, including immigration status and its implications for formal employment and health access, mental wellbeing, quality-of-life in the Dominican Republic, navigating sex work, perceptions of sex work, SRH knowledge, and limited social support. Findings of the quantitative analysis indicated that most participants reported feeling depressed (78%), lonely/isolated (75%), and having difficulty sleeping (88%). Participants reported an average of 10 sexual partners in the past 30 days; 55% had engaged in sexual practices while under the influence of alcohol; and only 39% had used a condom when performing oral sex in the past 30 days. Regarding AIDS/HIV, 79% had taken an HIV test in the past 6 months, and 74% knew where to seek HIV services. Conclusions. This mixed-methods study found that nationality and social exclusion have a multilayered influence on migrant female sex workers, sexual risk behaviors, and access to health care. Recommendations for effective evidence-based interventions to address sexual health knowledge need to be implemented to address risky sexual behaviors, improve access to SRH, and reduce affordability barriers.

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RESUMO Objetivo. Identificar comportamentos sexuais de risco e barreiras aos cuidados de saúde sexual e reprodutiva (SSR) entre trabalhadoras do sexo venezuelanas que vivem na República Dominicana. Métodos. Estudo de métodos mistos. Foram realizadas quatro discussões com grupos focais e uma pesquisa quantitativa transversal com trabalhadoras do sexo migrantes venezuelanas. O estudo foi realizado de setembro a outubro de 2021 em dois áreas urbanas (Santo Domingo e Puerto Plata) da República Dominicana. As informações coletadas dos grupos focais foram analisadas por meio de análise temática de conteúdo, e os dados quantitativos foram analisados por meio de estatísticas descritivas univariadas. A análise dos dados foi realizada de 30 de novembro de 2021 a 20 de fevereiro de 2022. Resultados. No total, 40 trabalhadoras do sexo migrantes venezuelanas, com mediana de idade de 33 anos (mínimo, 19; máximo, 49), participaram dos grupos focais e da pesquisa. Os grupos focais identificaram barreiras aos serviços de SSR, incluindo status de imigração e suas repercussões para o emprego formal e o acesso à saúde, bem-estar mental, qualidade de vida na República Dominicana, navegação do trabalho sexual, percepções do trabalho sexual, conhecimento de SSR e apoio social limitado. Conforme a análise quantitativa, a maioria das participantes relatou sentir-se deprimida (78%), solitária/isolada (75%) e com dificuldade para dormir (88%). As participantes relataram uma média de 10 parceiros sexuais nos últimos 30 dias; 55% praticaram sexo sob efeito de álcool; e apenas 39% usaram preservativo na prática de sexo oral nos últimos 30 dias. Em relação ao HIV/aids, 79% fizeram teste de HIV nos últimos 6 meses e 74% sabiam onde procurar serviços de HIV. Conclusões. Este estudo de métodos mistos constatou que a nacionalidade e a exclusão social têm uma influência multifacetada nas trabalhadoras do sexo migrantes, nos comportamentos sexuais de risco e no acesso à atenção à saúde. É preciso implementar recomendações para intervenções eficazes e baseadas em evidências para abordar o conhecimento da saúde sexual, visando a abordar comportamentos sexuais de risco, melhorar o acesso aos serviços de SSR e reduzir as barreiras de acessibilidade.

Self-perceived health of older adults in Latin America and the Caribbean: a scoping review / Revisión exploratoria sobre la autopercepción de la salud por las personas mayores en América Latina y el Caribe / Autopercepção de saúde de pessoas idosas na América Latina e no Caribe: revisão de escopo

ABSTRACT Objective. To systematically map the existing evidence on self-perceived health among adults aged 60 and older in Latin America and the Caribbean, describe the use of the single-item measure of self-perceived health with this population, and identify gaps in the existing literature. Methods. Following PRISMA Extension for Scoping Reviews guidelines, eight databases were searched for publications that were published between 2009 and 2019 and reported self-perceived health of adults over 60 years old in Latin America and the Caribbean. Data on study characteristics, sample characteristics, and the use and analysis of the self-perceived health measure were charted. Results. The database and secondary searches identified 516 articles. After removing duplicates and assessing titles and abstracts for inclusion, 263 full-text articles were assessed for eligibility using the inclusion criteria and an additional 89 articles were excluded. Ultimately, 174 articles were included in the scoping review. Studies included participants from 17 countries in the region, led in frequency by Brazil with 120 articles. The self-perceived health question most often included a five-category response scale (130), and response options were predominantly divided into two (86) or three (48) categories for analysis. Conclusions. Information on the health and social needs of people aged 60 and older across Latin America and the Caribbean, particularly their perceptions of health, is limited. We highlight the need to expand research throughout the region, include particularly vulnerable populations, utilize data from longitudinal and qualitative studies, and call for transparency in how questions and responses are worded and analyzed. This review serves to inform future studies, programs, and policies directed at this population.

RESUMEN Objetivo. Realizar una búsqueda sistemática de la evidencia sobre la autopercepción de la salud en las personas mayores de 60 años en América Latina y el Caribe, describir el uso de la medición basada en un solo ítem para dicha autopercepción en este grupo poblacional y detectar posibles lagunas en la bibliografía existente. Métodos. Se realizaron búsquedas en ocho bases de datos de publicaciones aparecidas entre el 2009 y el 2019 sobre la autopercepción de la salud por las personas mayores de 60 años en América Latina y el Caribe. Las búsquedas se realizaron de conformidad con la guía de la extensión PRISMA para revisiones exploratorias. Se graficaron los datos sobre las características del estudio, las características de la muestra y el uso y análisis de la medición de autopercepción de la salud. Resultados. Las búsquedas en las bases de datos y las secundarias permitieron localizar 516 artículos. Tras eliminar los duplicados y examinar los títulos y resúmenes para su inclusión, se utilizaron los criterios de inclusión para evaluar la admisibilidad de 263 artículos completos y se excluyeron otros 89 artículos. A fin de cuentas, quedaron seleccionados 174 artículos para la revisión exploratoria. Los estudios incluían participantes de 17 países de la región, con Brasil como el país con el mayor número (120 artículos). Lo más frecuente fue que la pregunta sobre autopercepción en materia de salud incluyera una escala de respuesta de cinco categorías (130), y las opciones de respuesta se dividían predominantemente en dos (86) o tres (48) categorías para su análisis. Conclusiones. La información sobre las necesidades sociales y de salud de las personas mayores de 60 años en América Latina y el Caribe, en particular sus percepciones sobre la propia salud, es limitada. Los autores destacan la necesidad de ampliar la investigación en toda la región, abarcar a los grupos poblacionales especialmente vulnerables, utilizar datos de estudios longitudinales y cualitativos y exhortar a la transparencia sobre la manera en que se formulan las preguntas y respuestas. Esta revisión sirve como fundamento para futuros estudios, programas y políticas orientados a este grupo poblacional.

RESUMO Objetivo. Mapear de forma sistemática as evidências existentes sobre a autopercepção de saúde em pessoas com 60 anos ou mais na América Latina e no Caribe, descrever o uso de uma medida de item único da autopercepção de saúde nessa população e identificar lacunas na literatura existente. Métodos. Em conformidade com as diretrizes da extensão da ferramenta PRISMA para revisões de escopo, oito bancos de dados foram pesquisados em busca de trabalhos publicados entre 2009 e 2019 que relatassem a autopercepção de saúde de pessoas com mais de 60 anos de idade na América Latina e no Caribe. Foram tabulados dados sobre as características do estudo, as características da amostra e o uso e a análise da medida de autopercepção de saúde. Resultados. As buscas nos bancos de dados e secundárias identificaram 516 artigos. Depois de descartar artigos repetidos e avaliar títulos e resumos para inclusão, 263 artigos completos foram avaliados quanto à elegibilidade usando os critérios de inclusão, o que levou à exclusão de mais 89 artigos. Por fim, 174 artigos foram incluídos na revisão de escopo. Os estudos incluíam participantes de 17 países da região, e o Brasil foi o país com o maior número de publicações: 120 artigos. A pergunta sobre a autopercepção de saúde incluía, na maioria das vezes, uma escala de resposta com cinco categorias (130), e as opções de resposta foram predominantemente divididas em duas (86) ou três (48) categorias para análise. Conclusões. As informações sobre as necessidades sociais e de saúde das pessoas com 60 anos ou mais na América Latina e no Caribe, especialmente suas percepções de saúde, são limitadas. Destacamos a necessidade de expandir a pesquisa em toda a região, incluir populações particularmente vulneráveis, utilizar dados de estudos longitudinais e qualitativos e solicitar transparência na forma como as perguntas e respostas são formuladas e analisadas. Esta análise serve de guia para futuros estudos, programas e políticas voltados para essa população.

Fertility decision-making during the Zika virus epidemic in Brazil: Where is the decision?

BACKGROUND: In 2016, a Public Health Emergency of International Concern (PHEIC) was declared in response to the rise of microcephaly cases among newborns in Northeastern Brazil. A common reactionary measure by public health authorities was to recommend women postpone pregnancy to avoid the possible perinatal transmission of Zika virus (ZIKV). METHODS: The purpose of this study was to assess how women in Fortaleza, Brazil conceptualize pregnancy; experience facilitators and barriers to pregnancy avoidance; perceive the authorities' recommendation to postpone pregnancy due to the ZIKV outbreak; and recall their experiences during the ZIKV epidemic. Qualitative methods, specifically a Rapid Anthropological Assessment (RAA), were utilized in this study. Data collection included semi-structured interviews, triangulated with observations and informal interviews with community members. RESULTS: The sample included 35 women (18-39 years old) who exclusively utilized the national public health care system. Findings indicated that all participants perceived the ZIKV pregnancy-postponement recommendation to be counter-cultural to Brazilian social norms. Overall women's self-perceived agency to prevent pregnancy was low due to social expectations and lack of trust for contraceptives. ZIKV prevention was not seen as a reason to utilize contraceptives. Interestingly, only women who self-perceived as more affluent were willing to attempt pregnancy prevention for educational, occupational, or financial opportunity. CONCLUSION: Pregnancy postponement as a response to a ZIKV epidemic ignores gaps in reproductive agency and defies social norms, making it unrealistic and counter-cultural. Future ZIKV health recommendations must be culturally aligned with the population, and address barriers and motivators for family planning.

World Health Organization and knowledge translation in maternal, newborn, child and adolescent health and nutrition.

The World Health Organization (WHO) has a mandate to promote maternal and child health and welfare through support to governments in the form of technical assistance, standards, epidemiological and statistical services, promoting teaching and training of healthcare professionals and providing direct aid in emergencies. The Strategic and Technical Advisory Group of Experts (STAGE) for maternal, newborn, child and adolescent health and nutrition (MNCAHN) was established in 2020 to advise the Director-General of WHO on issues relating to MNCAHN. STAGE comprises individuals from multiple low-income and middle-income and high-income countries, has representatives from many professional disciplines and with diverse experience and interests.Progress in MNCAHN requires improvements in quality of services, equity of access and the evolution of services as technical guidance, community needs and epidemiology changes. Knowledge translation of WHO guidance and other guidelines is an important part of this. Countries need effective and responsive structures for adaptation and implementation of evidence-based interventions, strategies to improve guideline uptake, education and training and mechanisms to monitor quality and safety. This paper summarises STAGE's recommendations on how to improve knowledge translation in MNCAHN. They include support for national and regional technical advisory groups and subnational committees that coordinate maternal and child health; support for national plans for MNCAHN and their implementation and monitoring; the production of a small number of consolidated MNCAHN guidelines to promote integrated and holistic care; education and quality improvement strategies to support guidelines uptake; monitoring of gaps in knowledge translation and operational research in MNCAHN.

Characteristics of Women Receiving Emergency Caesarean Section: A Cross-Sectional Analysis from Ghana and Dominican Republic.

BACKGROUND: Significant inequalities still exist between low- and high-income countries regarding access to optimum emergency obstetric care including life-saving emergency caesarean section. These relationships are considerably stronger between population-based caesarean section rates and socio-economic characteristics with poorest households experiencing significant unmet needs persistently. OBJECTIVE: To explore the characteristics of women receiving emergency C-section using a new, validated definition in Ghana and the Dominican Republic. MATERIALS AND METHODS: This was a cross-sectional study conducted in Ghana and the Dominican Republic. Multivariable logistic regression analysis was used to determine women's characteristics associated with emergency C-section. RESULTS: This analysis included 2166 women who had recently delivered via C-section comprising 653 and 1513 participants from Accra and Santo Domingo, DR, respectively. Multivariable analyses showed that women, both in Ghana and the DR, were more likely to have an emergency C-section if they did not have a previous C-Section (adjusted Odds Ratio (aOR): 2.45, 95% CI [1.57-3.81]; and aOR: 15.5, 95% CI [10.5-22.90], respectively) and if they were having their first childbirth, compared to women with previous childbirth (aOR: 1.77, 95%CI [1.13-2.79]; and aOR: 1.46, 95%CI [1.04-2.04], respectively). Also, preterm birth was associated with significantly decreased likelihood of emergency C-section compared with childbirth occurring at term in both Ghana and the DR (aOR: 0.31, 95%CI [0.20-0.48]; and aOR: 0.43, 95%CI [0.32-0.58], respectively). Among the Ghanaian participants, having an emergency C-section was positively associated with being referred and negatively associated with being older than 35 years of age. Characteristics such as education, religion, marital status, and residence did not differ between women's emergency versus non-emergency C-section status. CONCLUSION: Emergency C-section was found to be significantly higher in women with no prior C-section or those having their first births but lower in those with preterm birth in both Ghana and the DR. Data from additional countries are needed to confirm the relationship between emergency C-section status and socio-economic and obstetric characteristics, given that the types of interventions required to assure equitable access to potentially life-saving C-section will be determined by how and when access to care is being denied or not available.

The role of sociodemographic and psychosocial variables in early childhood development: A secondary data analysis of the 2014 and 2019 Multiple Indicator Cluster Surveys in the Dominican Republic.

The association between sociodemographic factors-poverty, lack of maternal schooling, being male at birth-, childhood developmental delay, and poor educational outcomes has been established in the Dominican Republic (DR). However, family moderating factors present or introduced to buffer sociodemographic factors effects on early childhood development (ECD) are still unknown. We conducted a secondary analysis of the DR's 2014 and 2019 Multiple Indicator Cluster Surveys. We had four study aims: 1) confirm the relationship between socioeconomic position (SP), parenting practices, and ECD; 2) determine if a sociodemographic model predicted ECD; 3) determine if a psychosocial model (family childrearing practices, discipline, and early childhood stimulation) predicted ECD above and beyond the sociodemographic model; 4) explore mothers' beliefs about physical punishment and its relationship with ECD and psychosocial variables. We found that both models predicted ECD significantly, but the psychosocial model explained more variance than the sociodemographic model (6.3% in 2014 and 4.4% in 2019). The most relevant sociodemographic predictors were SP (explaining 21.6% of ECD variance in 2014 and 18.6% in 2019) and mother's education (explaining 13.9% in 2014 and 14.1% in 2019). The most salient ECD psychosocial predictors were: negative discipline, number of children's books at home, stimulating activities at home, and attendance to an early childhood education program. The predicting weights of the independent variables were similar for both years. These results have multiple implications for social programs that aim to improve children's potential in contexts of poverty. Although the results show a protective effect of psychosocial factors, sustainable and large-scale interventions should not be limited to just buffering effects, but to solve the underlying problem, which is that poverty prevents children from reaching their developmental potential and exposes them to life-long greater risk for chronic disease. Addressing delays early in life can therefore contribute to achieving health equity.

[Disruption of health services for pregnant women, newborns, children, adolescents, and women during the COVID-19 pandemic: ISLAC 2020 ProjectInterrupção dos serviços de saúde para grávidas, recém-nascidos, crianças, adolescentes e mulheres durante a pandemia de COVID-19: projeto ISLAC 2020]. / Interrupción de servicios de salud para embarazadas, recién nacidos, niños y niñas, adolescentes y mujeres durante la pandemia de COVID-19: proyecto ISLAC 2020.

OBJECTIVE: Describe the perceptions of key actors regarding the disruption of health services for populations that ceased to be prioritized because of the COVID-19 pandemic-pregnant women, newborn, children, adolescents, and women-in countries of Latin America and the Caribbean (LAC) during the first stage of the pandemic. METHODS: In this cross-sectional study, a 35-question survey was administered to key actors in 19 LAC countries between July and September 2020. The respondents were asked for their personal perceptions regarding the situation of social and health services in their country before and during the pandemic. They were also asked for a projection of the situation during the post-pandemic period. RESULTS: In the 691 responses received, the main perception was that coverage in the services analyzed had been high before the pandemic, although their quality was not as highly rated. Both the coverage and quality of services were thought to have declined for adolescents and women. The majority of respondents predicted that all services will continue to function at lower than usual coverage levels for another three months (53.1%) and another 12 months (41.3%). Guaranteeing coverage and access to health services was considered the main policy challenge going forward. The next most needed initiatives noted were financing for actions to support women, children, and adolescents, and protection against violence and promotion of measures to combat it. CONCLUSIONS: Although the pandemic has struck all countries, its effect on the delivery of services in the populations analyzed differs from country to country and according to the types of service. It is essential to invest in national information systems that will make it possible to monitor the different services and identify the populations that need to be prioritized.

OBJETIVOS: Descrever a percepção de atores-chave na interrupção dos serviços de saúde para populações não priorizadas na pandemia ­ grávidas, recém-nascidos, crianças, adolescentes e mulheres ­ em países da América Latina e do Caribe (ALC) durante a primeira fase da pandemia de COVID-19. MÉTODOS: Estudo transversal. Foi realizada uma pesquisa com atores relevantes de 19 países da ALC entre julho e setembro de 2020, com 35 perguntas sobre a percepção pessoal do estado dos serviços sociais e de saúde em seus países antes e durante a pandemia, bem como uma projeção para depois dela. RESULTADOS: Nas 691 respostas, predominou a percepção de que a cobertura dos serviços analisados era alta antes da pandemia, embora a qualidade fosse vista como mais baixa. Notou-se uma redução na cobertura e na qualidade dos serviços a adolescentes e mulheres. A maioria estimou que todos os serviços seguiriam com uma menor cobertura tanto em 3 como em 12 meses (53,1% e 41,3%, respectivamente). Garantir a cobertura e o acesso aos serviços de saúde é o principal desafio político para o futuro, seguido do financiamento de iniciativas para mulheres, crianças e adolescentes, e da proteção e promoção contra a violência. CONCLUSÕES: Embora a pandemia tenha afetado todos os países, o abalo na provisão de serviços para as populações analisadas é heterogêneo entre os países e os tipos de serviço. É preciso investir em sistemas de informação nacionais que permitam monitorar os distintos serviços e identificar as populações que não foram priorizadas.

Interrupción de servicios de salud para embarazadas, recién nacidos, niños y niñas, adolescentes y mujeres durante la pandemia de COVID-19: proyecto ISLAC 2020

[RESUMEN]. Objetivos. Describir la percepción de actores clave sobre la interrupción de los servicios de salud para poblaciones no priorizadas por la pandemia —embarazadas, recién nacidos, niños y niñas, adolescentes y mujeres— en países de América Latina y el Caribe (ALC) durante la primera etapa de la pandemia de COVID-19. Métodos. Estudio transversal. Se aplicó una encuesta a actores relevantes de 19 países de ALC entre julio y septiembre del 2020, con 35 preguntas sobre su percepción personal del estado de los servicios sociales y de salud en su país antes y durante la pandemia, así como una proyección para después de ella. Resultados. En las 691 respuestas, predominó la percepción de que la cobertura de servicios analizados era alta antes de la pandemia, aunque su calidad se apreció menor. Se percibió una reducción de la cobertura y la calidad de los servicios a adolescentes y mujeres. La mayoría estimó que todos los servicios seguirían con una menor cobertura tanto a los 3 como a los 12 meses (53,1% y 41,3%, respectivamente). Garantizar la cobertura y el acceso a los servicios de salud es el principal desafío político con vista al futuro, seguido del financiamiento de iniciativas para mujeres, niños, niñas y adolescentes, y la protección y promoción contra la violencia. Conclusiones. Aunque la pandemia ha golpeado a todos los países, la afectación en la provisión de servicios para las poblaciones analizadas es heterogénea entre países y tipos de servicio. Se requiere invertir en sistemas de información nacionales que permitan monitorear los distintos servicios e identificar las poblaciones que no se han priorizado.

[ABSTRACT]. Objective. Describe the perceptions of key actors regarding the disruption of health services for populations that ceased to be prioritized because of the COVID-19 pandemic—pregnant women, newborn, children, adolescents, and women—in countries of Latin America and the Caribbean (LAC) during the first stage of the pandemic. Methods. In this cross-sectional study, a 35-question survey was administered to key actors in 19 LAC countries between July and September 2020. The respondents were asked for their personal perceptions regarding the situation of social and health services in their country before and during the pandemic. They were also asked for a projection of the situation during the post-pandemic period. Results. In the 691 responses received, the main perception was that coverage in the services analyzed had been high before the pandemic, although their quality was not as highly rated. Both the coverage and quality of services were thought to have declined for adolescents and women. The majority of respondents predicted that all services will continue to function at lower than usual coverage levels for another three months (53.1%) and another 12 months (41.3%). Guaranteeing coverage and access to health services was considered the main policy challenge going forward. The next most needed initiatives noted were financing for actions to support women, children, and adolescents, and protection against violence and promotion of measures to combat it. Conclusions. Although the pandemic has struck all countries, its effect on the delivery of services in the populations analyzed differs from country to country and according to the types of service. It is essential to invest in national information systems that will make it possible to monitor the different services and identify the populations that need to be prioritized.

[RESUMO]. Objetivos. Descrever a percepção de atores-chave na interrupção dos serviços de saúde para populações não priorizadas na pandemia — grávidas, recém-nascidos, crianças, adolescentes e mulheres — em países da América Latina e do Caribe (ALC) durante a primeira fase da pandemia de COVID-19. Métodos. Estudo transversal. Foi realizada uma pesquisa com atores relevantes de 19 países da ALC entre julho e setembro de 2020, com 35 perguntas sobre a percepção pessoal do estado dos serviços sociais e de saúde em seus países antes e durante a pandemia, bem como uma projeção para depois dela. Resultados. Nas 691 respostas, predominou a percepção de que a cobertura dos serviços analisados era alta antes da pandemia, embora a qualidade fosse vista como mais baixa. Notou-se uma redução na cobertura e na qualidade dos serviços a adolescentes e mulheres. A maioria estimou que todos os serviços seguiriam com uma menor cobertura tanto em 3 como em 12 meses (53,1% e 41,3%, respectivamente). Garantir a cobertura e o acesso aos serviços de saúde é o principal desafio político para o futuro, seguido do financiamento de iniciativas para mulheres, crianças e adolescentes, e da proteção e promoção contra a violência. Conclusões. Embora a pandemia tenha afetado todos os países, o abalo na provisão de serviços para as populações analisadas é heterogêneo entre os países e os tipos de serviço. É preciso investir em sistemas de informação nacionais que permitam monitorar os distintos serviços e identificar as populações que não foram priorizadas.