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

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

A composite index; socioeconomic deprivation and coverage of reproductive and maternal health interventions.

Objective: To examine inequalities in the coverage of reproductive and maternal health interventions in low- and middle-income countries and territories using a composite index of socioeconomic deprivation status. Methods: We obtained data on education and living standards from national household surveys conducted between 2015 and 2019 to calculate socioeconomic deprivation status. We assessed the coverage of reproductive and maternal health interventions, using three indicators: (i) demand for family planning satisfied with modern methods; (ii) women who received antenatal care in at least four visits; and (iii) the presence of a skilled attendant at delivery. Absolute and relative inequalities were evaluated both directly and using the slope index of inequality and the concentration index. Findings: In the 73 countries and territories with available data, the median proportions of deprivation were 41% in the low-income category, 11% in the lower-middle-income category and less than 1% in the upper-middle-income category. The coverage analysis, conducted for 48 countries with sufficient data, showed consistently lower median coverage among deprived households across all health indicators. The coverage of skilled attendant at delivery showed the largest inequalities, where coverage among the socioeconomically deprived was substantially lower in almost all countries. Antenatal care visits and demand for family planning satisfied with modern methods also showed significant disparities, favouring the less deprived population. Conclusion: The findings highlight persistent disparities in the coverage of reproductive and maternal health interventions, requiring efforts to reduce those disparities and improve coverage, particularly for skilled attendant at delivery.

Macro level system mapping of the provision of mental health services to young people living in a conflict context in Colombia.

Colombia has one of the longest running internal armed conflicts, which has significantly impacted the mental health of the population. This article is the first to present a national level mapping of the provision of mental health services to young people living in Colombia, through detailed review of documentation, interviews with key stakeholders and quantitative analysis of existing data on mental health and suicide. It explores the existing public mental health provision in the country, focussing on where mental health resources are concentrated and how these are implemented. We use this mapping to understand how the current mental health system in Colombia fits with international approaches to youth mental health. We show that whilst mental health policy is variously framed (biomedical, biosocial, psychologically or through human rights), Colombian policy clearly focusses on a differential approach. This differential approach shapes service provision to target support at those in need, consequently neglecting whole population level mental health support. This means that not all stakeholders were clearly articulated or included in policy and that key institutional stakeholders, such as the education sector, were not linked to implementation plans or activity. Policy approaches were also over-centralised with little cross-institutional collaboration. Youth were specifically missing from services, as was explicit understanding of the intergenerational effects and impact of conflict. This was exacerbated by unequal distribution of mental health care services concentrated in populous, urban areas away from conflict-affected regions. Suicide is the second most prevalent cause of death with 10% of population who were recorded as dying by violence, dying from completed suicide. Triangulation implies a strong relationship between suicide and poorer access to professional support in conflict-affected areas and suggests that international frameworks and policy approaches to supporting youth mental health have been insufficiently adapted for conflict and post conflict contexts.

Changing levels of income and multidimensional poverty among persons with disabilities in Colombia: A pseudo panel analysis.

In Colombia, more than 4 per cent of the population lives with disability and high levels of income and multidimensional poverty have been recognised within this group. However, there is no information on how the levels of poverty have changed over time or whether households with members with disabilities are more likely to be chronically poorer than households without disabilities in the country. In addition, no evidence exists on the potential effect of the Covid-19 pandemic on the socioeconomic characteristics of persons with disability. This study aims to contribute to the literature on this topic by analysing a nationally representative survey (Quality of Life Survey) from 2018 to 2022 and studying the changes in the levels of income and multidimensional poverty of persons with disabilities and their household, and identifying whether any changes associated with the Covid-19 pandemic.

What cut-off(s) to use with the Washington Group short set of questions?

The Washington Group short set (WG-SS) questions are increasingly integrated into national household surveys, censuses, and international survey programs. They enable the monitoring of disability rights and the production of internationally comparable statistics. Disability statistics on prevalence and inequalities can be estimated using different cut-offs on the degree of functional difficulties based on the WG-SS. This commentary discusses what cut-offs to adopt for the purpose of investigating and monitoring disability gaps. We recommend a three-way disaggregation comparing persons with (a) no difficulty, (b) some difficulty and (c) a lot of difficulty or unable to do. In cases where sample sizes are small for disaggregated analysis, we recommend comparing persons with no difficulty to persons with any level of difficulty (i.e. persons with any disability).

Cost-effectiveness analysis of spontaneous vaginal delivery vs elective cesarean delivery for maternal outcomes in Colombia.

BACKGROUND: In worldwide literature, it has been found that cesarean deliveries represent higher costs and are associated with maternal morbidity and other complications. OBJECTIVE: This study aimed to estimate the cost-effectiveness of elective cesarean delivery compared with spontaneous vaginal delivery in short-term maternal outcomes for low-risk obstetrical population in Colombia. STUDY DESIGN: A cost-effectiveness study using a healthcare-system perspective was performed in 2019 in Colombia. The reference population were women with full-term and low-risk pregnancy, either by spontaneous vaginal delivery or elective cesarean delivery under medical or nonmedical indications. An analytical decision model (decision tree) was designed for maternal outcomes. The time horizon was 42 days postpartum, and the health effects were measured by Quality Adjusted Life Years. A review of the literature and a validation process by a national expert committee were conducted to determine the maternal outcomes and estimate their probabilities. Costs were estimated with a top-down analysis, an incremental cost-effectiveness ratio was calculated, and finally, a sensitivity analysis was performed. RESULTS: Within a 42-day time horizon, it was found that spontaneous vaginal delivery is the less-expensive and more-effective mode of delivery, it showed a reduction in costs (324 USD) and a gain in Quality Adjusted Life Years (0.03) compared with elective cesarean delivery. Our analysis suggests that spontaneous vaginal delivery is the dominant alternative compared with elective cesarean delivery. CONCLUSION: Spontaneous vaginal delivery showed to be the cost-effective mode of delivery for low-risk obstetrical population in Columbia. These results are useful not only for obstetricians but for decision makers, who should encourage nationwide health policies in favor of spontaneous vaginal delivery.

What are the factors associated with catastrophic health expenditure in Colombia? A multi-level analysis.

INTRODUCTION: Target 3.8 of the Sustainable Development Goals calls for the guaranteeing of universal health service coverage without generating financial risks for households and individuals. In Colombia, there is no up-to-date information on the proportion of households that suffer catastrophic health expenditure (CHE), nor about how these expenses are associated with the place of residence. To contribute to an understanding of these issues, this study analyses the differences in the levels of CHE among Colombian households, and their association with the province and area (urban or rural) of residence. METHODS: This is a descriptive and analytical cross-sectional study using the 2016-2017 National Household Budget Survey, the household and population Census 2018, and the Register of Health Providers 2017. We used the definition of CHE proposed by the World Health Organization, with a threshold of 20%. We estimated the percentage of households facing CHE, and its intensity, and estimated a multi-level logistic regression model, using as the dependent variable the question of whether a household experienced CHE, and the province as a second level, where explanatory variables related to the province were included. RESULTS: We found differences in CHE levels according to the province of residence. At the national level, 1.77% of households experienced CHE, and households in the provinces of Boyacá (5.04%), Nariño (4.04%), Cauca (3.82%), and Chocó (3.78%) faced the highest CHE. For most households with CHE in these provinces, spending on medicines and medical consultations represented close to 50% of their out-of-pocket spending. The multi-level logistic regression model indicated that there are significant variations in CHE attributed to the provinces under study, where the contextual variables of hospital-bed density (AOR = 0.91; 95% CI 0.86-0.96) and incidence of multi-dimensional poverty (AOR = 1.13; 95% CI 1.01-1.30) were factors associated with CHE. For an urban household, 6.58% of the CHE variation is attributed to the province in question, while for a rural household the corresponding variation is 1.56%. CONCLUSIONS: The geographical location of the household is a key factor when studying CHE in Colombia, where rural households present higher levels of CHE, mainly in the delivery of medicines and medical consultations. The findings reveal the need to analyse financial protection at the local level and establish policies to protect households, especially poor households, from CHE.

Multidimensional poverty among persons with disabilities in Colombia: Inequalities in the distribution of deprivations at the municipality level.

According to the national population Census of Colombia, 4.1 per cent of the population lives with a disability. Although information is available on the number of persons with disabilities in the country, little information exists on their levels of multidimensional poverty and deprivation, especially at the province of local level. Aiming to contribute to the analysis of the levels of poverty of persons with disabilities living at the municipal/province level, this study computes and analyses the levels of multidimensional poverty in households with and without members with disabilities in the 1.101 municipalities of Colombia. Using the 2018 national population census, we computed the percentage of people living with disabilities in each of the municipalities of the country, then we computed their levels of poverty and deprivation and analysed the difference between households with and without members with disabilities. We also analysed the availability of teachers and schools providing services for children living with disabilities and deprivations in terms of school attendance. The results reveal that households with members with disabilities are poorer than households without members with disabilities, These households present higher deprivations according to most indicators, and the intensity of their poverty is higher. In addition, households with members with disabilities usually present higher levels of deprivation in school attendance and live in municipalities where there is no provision of inclusive schools. These results highlight the importance of implementing specific policies designed to reduce the levels of poverty of persons with disabilities and their families and to guarantee their access to basic opportunities and services.

Catastrophic health-care payments and multidimensional poverty: Are they related?

The negative impact of health-related out-of-pocket (OOP) payments is a well-known problem in low and middle-income countries (LMICs). Cross-sectional analysis reveals that households use different coping mechanisms to mitigate or overcome the effect of OOP payments, but little is known from a longitudinal perspective. We explore this link using panel data for Colombia, Mexico, India, Malawi, Nigeria, Uganda, and Tanzania. Using a fixed-effect model, we computed the association between multidimensional poverty (MP) and facing catastrophic health payments (CHP) using a capacity-to-pay approach. We estimated different heterogeneous effects, including variables such as area of residence, facing CHP, being poor in the first wave, and facing CHP in period two. While using cross-sectional data, we found that the association between CHP and MP is present for six of the seven countries; it is not the case for the time variation in most of them. The results provide evidence that OOP induce a long-term impact on MP only in Colombia, India and Nigeria. In the last two countries, the levels of poverty and CHP were the highest of all seven, and the association between both situations was found by using different poverty cutoffs and thresholds to define CHP.

External validation of the ACC/AHA ASCVD risk score in a Colombian population cohort.

No cardiovascular risk score has included Latin American patients in its development. The ACC/AHA ASCVD risk score has not been validated in Latin America; consequently, its predictive capacity in the population of the region is unknown. The aim of this study is to evaluate the discrimination capacity and calibration of the ACC/AHA ASCVD score to predict the 10-year risk of a cardiovascular event in a primary prevention cohort followed in a Colombian hospital. A retrospective cohort study was conducted in primary prevention patients belonging to an intermediate/high-risk and low-risk cohort without established atherosclerotic disease. Cardiovascular risk was calculated at inclusion. The calibration was analyzed by comparing observed and expected events in the different risk categories. A discrimination analysis was made using the area under the ROC curve and C statistic. A total of 918 patients were included-202 from the intermediate/high-risk and 716 from the low-risk cohort. The median cardiovascular risk was 3.6% (IQR 1.7-8.5%). At the 10-year follow-up, 40 events (4,4%) occurred. The area under the ROC curve was 0.782 (95% CI 0.71-0.85). The Hosmer-Lemeshow test did not show differences between expected and observed events. The ACC/AHA ASCVD score is calibrated and has good discrimination capacity in predicting 10-year risk of cardiovascular events in a Colombian population.

Multidimensional Measures and the Extra Costs of Disability: How Are They Related?

People with disabilities are more likely than individuals without disabilities to face higher levels of deprivation and multidimensional poverty, and those deprivations might be associated with the extra costs of living with a disability. However, there has not been an analysis of how multidimensional poverty measures are related to the extra costs of disability or whether these measures can be used as a proxy of the standard of living in the analysis of the extra costs of disability. This paper aims to analyse whether multidimensional poverty measures can be used to study the extra costs of disability and, based on the capability approach, how multidimensional poverty is related to the extra costs of disability. This paper discusses theoretical, technical, and methodological aspects to be considered when studying the relationship between extra costs and multidimensional poverty, and we used data from Chile and Nigeria to illustrate this relationship. We conclude that when analysing the extra costs of disability, multidimensional measures might be an option; however, it is necessary to clearly stablish the relationship among income, deprivation, and the extra costs of disability.

Social Capital and Lifestyle Impacts on Mental Health in University Students in Colombia: An Observational Study.

Introduction: For young adults, the first year of higher education represents a transition period into adulthood associated with an increased risk of developing depression, anxiety, and stress, contributing to deteriorating physical and mental health. The present study aimed to analyze the relationship between depressive symptoms and social capital and lifestyles among Colombian university students. Methods: In 2020, a longitudinal repeated measures study was conducted on first year students at Universidad de los Andes in Bogota, Colombia. The study was conceptualized and approved by the university before the COVID-19 pandemic appeared. Each student completed a self-administered questionnaire including questions on sociodemographic characteristics, depressive symptoms, perceived stress, social capital, and lifestyles. The study's pilot was conducted in November 2019, and the two measurement points were in January 2020 (wave 1, before the COVID-19 pandemic was declared) and in August 2020 (wave 2, during the COVID-19 pandemic). A binary logistic regression analysis was performed to assess the relationship between depressive symptoms, perceived stress, social capital, and lifestyles. Findings: A total of 609 first year students (response rate = 58.11%) participated in wave 1, and 42% of the participants showed signs of clinically relevant depressive symptoms. In wave 2, despite the difficulties encountered in collecting data due to the COVID-19 pandemic, 216 students from wave 1 participated (35.47%). An increase in a sedentary lifestyle was observed (31.49%). We found that cognitive and behavioral social capital levels decreased by 12.03 and 24.54%, respectively. In addition, we observed a 6.5% increase in students with clinically relevant depressive symptoms compared to wave 1. A low level of behavioral [OR: 1.88; 95% CI (1.16, 3.04)] social capital was associated with clinically relevant depressive symptoms. Conclusion: The health of university students continues to be a public health concern. The study suggests that social capital may play an important role in preventing depressive symptoms. Therefore, universities should put effort into programs that bring students together and promote the creation of social capital.

[Data collection and inclusion of the population with disabilities during the COVID-19 pandemic in Latin America and the CaribbeanColeta de dados na pandemia de COVID-19 e a inclusão de pessoas com deficiência na América Latina e no Caribe]. / Recolección de datos durante la pandemia por la COVID-19 y la inclusión de la población con discapacidad en América Latina y el Caribe.

Objective: To identify surveys that included questions about disability during the COVID-19 pandemic, in the period 2020-2021; and based on this, to determine what actions the countries of Latin America and the Caribbean implemented in the areas of education, health, and social protection that explicitly included the population with disabilities. Methods: Documents from the national statistics institutes of the countries of the region were reviewed, as well as the Socioeconomic Impact Assessment platform and webpages of international institutions such as the World Bank, the United Nations Development Program, and the Economic Commission for Latin America and the Caribbean, seeking to identify national or regional surveys implemented during 2020 and the first half of 2021. Additionally, a documentary analysis was conducted of the measures implemented in the health, education, and social protection sectors in response to the COVID-19 pandemic. These documents were studied to determine whether the population with disabilities was explicitly mentioned. Results: Twenty-three countries in Latin America and the Caribbean collected information from statistical surveys during 2020-2021. Of these, only four (Colombia, Costa Rica, Mexico, and Peru) included questions on disability in their national surveys and although some specific surveys were conducted for the population with disabilities, in the region there is a general lack of associated data on this population during the pandemic. Only 10 countries explicitly included the population with disabilities in health measures, 12 in education, and 13 in social protection. Conclusions: The lack of data on the population with disabilities in the countries of Latin America and the Caribbean during the COVID-19 pandemic shows that this population remains invisible in information collection processes. This is associated with the low number of countries that explicitly included the population with disabilities in policies implemented to mitigate the impact of the pandemic.

Objetivo: Identificar pesquisas que incluíram perguntas sobre deficiência realizadas no período de 2020-2021 da pandemia de COVID-19 e, a partir dessa informação, determinar as ações em saúde, educação e assistência social empreendidas nos países da América Latina e do Caribe e que incluíram explicitamente pessoas com deficiência. Métodos: Documentação obtida dos institutos nacionais de estatística dos países da Região, da plataforma Socioeconomic Impact Assessment (avaliação do impacto socioeconômico) e de sites de organismos internacionais (como Banco Mundial, Programa das Nações Unidas para o Desenvolvimento e Comissão Econômica para a América Latina e o Caribe) foi analisada com o objetivo de identificar as pesquisas nacionais ou regionais realizadas em 2020 e no primeiro semestre de 2021. Também foi realizada uma pesquisa documental da regulamentação para ações em saúde, educação e assistência social destinadas a enfrentar a pandemia de COVID-19, com vistas a identificar a menção explícita de pessoas com deficiência. Resultados: Vinte e três países da América Latina e do Caribe fizeram a coleta de dados estatísticos em pesquisas realizadas no período 2020-2021. Apenas quatro países incluíram perguntas sobre deficiência em pesquisas nacionais: Colômbia, Costa Rica, México e Peru. Apesar de ter havido pesquisas direcionadas para pessoas com deficiência, a Região em geral carece de dados relativos à situação dessa população na pandemia. Somente 10 países empreenderam ações em saúde com a inclusão explícita de pessoas com deficiência, 12 em educação e 13 em assistência social. Conclusões: A falta de dados sobre a situação das pessoas com deficiência nos países da América Latina e do Caribe durante a pandemia de COVID-19 demonstra a invisibilidade deste segmento populacional nos processos de coleta de dados. Como resultado, um número reduzido de países incluiu explicitamente as pessoas com deficiência nas políticas implementadas para o enfrentamento da pandemia.

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

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

Recolección de datos durante la pandemia por la COVID-19 y la inclusión de la población con discapacidad en América Latina y el Caribe

[RESUMEN]. Objetivo. Identificar las encuestas que incluyeron preguntas sobre discapacidad durante la pandemia por la COVID-19, en el periodo 2020-2021; y a partir de esto, estudiar qué acciones han implementado los países de América Latina y el Caribe en aspectos educativos, de salud y protección social que han incluido explícitamente a la población con discapacidad. Métodos. Se revisaron los documentos de los Institutos Nacionales de Estadística de los países de la región, al igual que la plataforma de Socioeconomic Impact Assessment y páginas de instituciones internacionales como el Banco Mundial, el Programa de las Naciones Unidas para el Desarrollo y la Comisión Económica para América Latina y el Caribe, buscando identificar las encuestas nacionales o regionales implementadas durante el 2020 y primer semestre de 2021. Adicionalmente, se realizó un análisis documental de las normas que implementaron medidas en los sectores de salud, educación y protección social como respuesta a la pandemia por la COVID-19. En estos documentos se buscó identificar si de manera explícita se mencionaba a la población con discapacidad. Resultados. De los países de América Latina y el Caribe, 23 recolectaron información estadística tipo encuesta durante el 2020 -2021. De estos, tan solo cuatro (Colombia, Costa Rica, Perú y México) incluyeron preguntas de discapacidad dentro de las encuestas nacionales y aunque se realizaron algunas encuestas específicas para la población con discapacidad, en general, en la región existe una falta de datos asociados de esta población durante la pandemia. Solo diez incluyeron explícitamente a la población con discapacidad en las medidas de salud, doce en educación y trece en protección social Conclusiones. La falta de datos sobre la población con discapacidad en los países de América Latina y el Caribe durante la pandemia por la COVID-19, muestra que esta población está invisibilizada dentro de los procesos de recolección de información, lo cual se asocia con el bajo número de países que implementaron políticas para mitigar el impacto de la pandemia que explícitamente incluyeron a la población con discapacidad.

[ABSTRACT]. Objective. To identify surveys that included questions about disability during the COVID-19 pandemic, in the period 2020–2021; and based on this, to determine what actions the countries of Latin America and the Caribbean implemented in the areas of education, health, and social protection that explicitly included the population with disabilities. Methods. Documents from the national statistics institutes of the countries of the region were reviewed, as well as the Socioeconomic Impact Assessment platform and webpages of international institutions such as the World Bank, the United Nations Development Program, and the Economic Commission for Latin America and the Caribbean, seeking to identify national or regional surveys implemented during 2020 and the first half of 2021. Additionally, a documentary analysis was conducted of the measures implemented in the health, education, and social protection sectors in response to the COVID-19 pandemic. These documents were studied to determine whether the population with disabilities was explicitly mentioned. Results. Twenty-three countries in Latin America and the Caribbean collected information from statistical surveys during 2020–2021. Of these, only four (Colombia, Costa Rica, Mexico, and Peru) included questions on disability in their national surveys and although some specific surveys were conducted for the population with disabilities, in the region there is a general lack of associated data on this population during the pandemic. Only 10 countries explicitly included the population with disabilities in health measures, 12 in education, and 13 in social protection. Conclusions. The lack of data on the population with disabilities in the countries of Latin America and the Caribbean during the COVID-19 pandemic shows that this population remains invisible in information collection processes. This is associated with the low number of countries that explicitly included the population with disabilities in policies implemented to mitigate the impact of the pandemic.

[RESUMO]. Objetivo. Identificar pesquisas que incluíram perguntas sobre deficiência realizadas no período de 2020- 2021 da pandemia de COVID-19 e, a partir dessa informação, determinar as ações em saúde, educação e assistência social empreendidas nos países da América Latina e do Caribe e que incluíram explicitamente pessoas com deficiência. Métodos. Documentação obtida dos institutos nacionais de estatística dos países da Região, da plataforma Socioeconomic Impact Assessment (avaliação do impacto socioeconômico) e de sites de organismos internacionais (como Banco Mundial, Programa das Nações Unidas para o Desenvolvimento e Comissão Econômica para a América Latina e o Caribe) foi analisada com o objetivo de identificar as pesquisas nacionais ou regionais realizadas em 2020 e no primeiro semestre de 2021. Também foi realizada uma pesquisa documental da regulamentação para ações em saúde, educação e assistência social destinadas a enfrentar a pandemia de COVID-19, com vistas a identificar a menção explícita de pessoas com deficiência. Resultados. Vinte e três países da América Latina e do Caribe fizeram a coleta de dados estatísticos em pesquisas realizadas no período 2020-2021. Apenas quatro países incluíram perguntas sobre deficiência em pesquisas nacionais: Colômbia, Costa Rica, México e Peru. Apesar de ter havido pesquisas direcionadas para pessoas com deficiência, a Região em geral carece de dados relativos à situação dessa população na pandemia. Somente 10 países empreenderam ações em saúde com a inclusão explícita de pessoas com deficiência, 12 em educação e 13 em assistência social. Conclusões. A falta de dados sobre a situação das pessoas com deficiência nos países da América Latina e do Caribe durante a pandemia de COVID-19 demonstra a invisibilidade deste segmento populacional nos processos de coleta de dados. Como resultado, um número reduzido de países incluiu explicitamente as pessoas com deficiência nas políticas implementadas para o enfrentamento da pandemia.

Exploring the potential for a new measure of socioeconomic deprivation status to monitor health inequality.

BACKGROUND: Monitoring health inequalities is an important task for health research and policy, to uncover who is being left behind - and where - and to inform effective and equitable policies and programmes to tackle existing inequities. The choice of which measure to use to monitor and analyse health inequalities is thereby not trivial. This article explores a new measure of socioeconomic deprivation status (SDS) to monitor health inequalities. METHODS: The SDS measure was constructed using the Alkire-Foster method. It includes eight indicators across two equally weighted dimensions (education and living standards) and specifies a four-level gradient of socioeconomic deprivation at the household-level. We conducted four exercises to examine the value-added of the proposed SDS measure, using Demographic and Health Surveys data. First, we examined the discriminatory power of the new measure when applied to outcomes in four select reproductive, maternal, neonatal, and child health (RMNCH) indicators across six countries: skilled birth attendance, stunting, U5MR, and DTP3 immunisation. Then, we analysed the behaviour and association of the new SDS measure vis-à-vis the DHS Wealth Index, including chi-squared test and Pearson correlation coefficient. Third, we analysed the robustness of the SDS measure results to changes in its structure, using pairwise comparisons and Kendal Tau-b rank correlation. Finally, we illustrated some of the advantageous properties of the new measure, disaggregation and decomposition, on Haitian data. RESULTS: 1) Higher levels of socioeconomic deprivation are generally consistently associated with lower levels of achievements in the RMNCH indicators across countries. 2) 87% of all pairwise rank comparisons across a range of SDS measure structures were robust. 3) SDS and DHS Wealth Index are associated, but with considerable cross-country variation, highlighting their complementarity. 4) Haitian households in rural areas experienced, on average, more severe socioeconomic deprivation as well as lower levels of RMNCH achievement than urban households. CONCLUSIONS: The proposed SDS measure adds analytical possibilities to the health inequality monitoring literature, in line with ethically and conceptually well-founded notions of absolute, multidimensional disadvantage. In addition, it allows for breakdown by its dimensions and components, which may facilitate nuanced analyses of health inequality, its correlates, and determinants.

Recolección de datos durante la pandemia por la COVID-19 y la inclusión de la población con discapacidad en América Latina y el Caribe / Data collection and inclusion of the population with disabilities during the COVID-19 pandemic in Latin America and the Caribbean / Coleta de dados na pandemia de COVID-19 e a inclusão de pessoas com deficiência na América Latina e no Caribe

RESUMEN Objetivo. Identificar las encuestas que incluyeron preguntas sobre discapacidad durante la pandemia por la COVID-19, en el periodo 2020-2021; y a partir de esto, estudiar qué acciones han implementado los países de América Latina y el Caribe en aspectos educativos, de salud y protección social que han incluido explícitamente a la población con discapacidad. Métodos. Se revisaron los documentos de los Institutos Nacionales de Estadística de los países de la región, al igual que la plataforma de Socioeconomic Impact Assessment y páginas de instituciones internacionales como el Banco Mundial, el Programa de las Naciones Unidas para el Desarrollo y la Comisión Económica para América Latina y el Caribe, buscando identificar las encuestas nacionales o regionales implementadas durante el 2020 y primer semestre de 2021. Adicionalmente, se realizó un análisis documental de las normas que implementaron medidas en los sectores de salud, educación y protección social como respuesta a la pandemia por la COVID-19. En estos documentos se buscó identificar si de manera explícita se mencionaba a la población con discapacidad. Resultados. De los países de América Latina y el Caribe, 23 recolectaron información estadística tipo encuesta durante el 2020 -2021. De estos, tan solo cuatro (Colombia, Costa Rica, Perú y México) incluyeron preguntas de discapacidad dentro de las encuestas nacionales y aunque se realizaron algunas encuestas específicas para la población con discapacidad, en general, en la región existe una falta de datos asociados de esta población durante la pandemia. Solo diez incluyeron explícitamente a la población con discapacidad en las medidas de salud, doce en educación y trece en protección social Conclusiones. La falta de datos sobre la población con discapacidad en los países de América Latina y el Caribe durante la pandemia por la COVID-19, muestra que esta población está invisibilizada dentro de los procesos de recolección de información, lo cual se asocia con el bajo número de países que implementaron políticas para mitigar el impacto de la pandemia que explícitamente incluyeron a la población con discapacidad.

ABSTRACT Objective. To identify surveys that included questions about disability during the COVID-19 pandemic, in the period 2020-2021; and based on this, to determine what actions the countries of Latin America and the Caribbean implemented in the areas of education, health, and social protection that explicitly included the population with disabilities. Methods. Documents from the national statistics institutes of the countries of the region were reviewed, as well as the Socioeconomic Impact Assessment platform and webpages of international institutions such as the World Bank, the United Nations Development Program, and the Economic Commission for Latin America and the Caribbean, seeking to identify national or regional surveys implemented during 2020 and the first half of 2021. Additionally, a documentary analysis was conducted of the measures implemented in the health, education, and social protection sectors in response to the COVID-19 pandemic. These documents were studied to determine whether the population with disabilities was explicitly mentioned. Results. Twenty-three countries in Latin America and the Caribbean collected information from statistical surveys during 2020-2021. Of these, only four (Colombia, Costa Rica, Mexico, and Peru) included questions on disability in their national surveys and although some specific surveys were conducted for the population with disabilities, in the region there is a general lack of associated data on this population during the pandemic. Only 10 countries explicitly included the population with disabilities in health measures, 12 in education, and 13 in social protection. Conclusions. The lack of data on the population with disabilities in the countries of Latin America and the Caribbean during the COVID-19 pandemic shows that this population remains invisible in information collection processes. This is associated with the low number of countries that explicitly included the population with disabilities in policies implemented to mitigate the impact of the pandemic.

RESUMO Objetivo. Identificar pesquisas que incluíram perguntas sobre deficiência realizadas no período de 2020-2021 da pandemia de COVID-19 e, a partir dessa informação, determinar as ações em saúde, educação e assistência social empreendidas nos países da América Latina e do Caribe e que incluíram explicitamente pessoas com deficiência. Métodos. Documentação obtida dos institutos nacionais de estatística dos países da Região, da plataforma Socioeconomic Impact Assessment (avaliação do impacto socioeconômico) e de sites de organismos internacionais (como Banco Mundial, Programa das Nações Unidas para o Desenvolvimento e Comissão Econômica para a América Latina e o Caribe) foi analisada com o objetivo de identificar as pesquisas nacionais ou regionais realizadas em 2020 e no primeiro semestre de 2021. Também foi realizada uma pesquisa documental da regulamentação para ações em saúde, educação e assistência social destinadas a enfrentar a pandemia de COVID-19, com vistas a identificar a menção explícita de pessoas com deficiência. Resultados. Vinte e três países da América Latina e do Caribe fizeram a coleta de dados estatísticos em pesquisas realizadas no período 2020-2021. Apenas quatro países incluíram perguntas sobre deficiência em pesquisas nacionais: Colômbia, Costa Rica, México e Peru. Apesar de ter havido pesquisas direcionadas para pessoas com deficiência, a Região em geral carece de dados relativos à situação dessa população na pandemia. Somente 10 países empreenderam ações em saúde com a inclusão explícita de pessoas com deficiência, 12 em educação e 13 em assistência social. Conclusões. A falta de dados sobre a situação das pessoas com deficiência nos países da América Latina e do Caribe durante a pandemia de COVID-19 demonstra a invisibilidade deste segmento populacional nos processos de coleta de dados. Como resultado, um número reduzido de países incluiu explicitamente as pessoas com deficiência nas políticas implementadas para o enfrentamento da pandemia.

Association Between Social Pensions With Depression, Social, and Health Behaviors Among Poor Older Individuals in Colombia.

OBJECTIVES: Many low- and middle-income countries have introduced social pensions to alleviate extreme poverty and improve the well-being of older individuals. However, evidence remains inconclusive about the potential effects of such programs on mental health, social, and health behaviors. METHODS: Data for individuals aged 60 or older came from the nationally representative Encuesta Nacional de Salud, Bienestar y Envejeciamiento survey in Colombia 2015 (N = 9,456). We used propensity score matching to estimate the association between the country's social pension program (Colombia Mayor) with depression, self-rated health, food insecurity, alcohol consumption, social participation, and labor force participation. RESULTS: Results show that receiving the program does not significantly affect the likelihood of suffering from depression or self-rated health among either men or women. However, receiving the program is associated with significant reductions in the likelihood of experiencing food insecurity and significant increases in the likelihood of participating socially. Among women, receiving the program is associated with significant reduction in the likelihood of participating in the labor force. DISCUSSION: The absence of a measurable effect on depression and self-rated health may be explained, at least partly, by the program's comparatively small cash benefit and the sharing of resources with other family members. Policymakers should assess possibilities to maximize the health and social benefits of social pensions.