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Background: Invasive pneumococcal diseases (IPD) are associated with high morbidity, mortality, and health costs worldwide, particularly in Latin America and the Caribbean (LAC). Surveillance about the distribution of serotypes causing IPD and the impact of pneumococcal vaccination is an important epidemiological tool to monitor disease activity trends, inform public health decision-making, and implement relevant prevention and control measures., Objectives: To estimate the serotype distribution for IPD and the related disease burden in LAC before, during, and after implementing the pneumococcal vaccine immunization program in LAC., Methods: Systematic literature review following Cochrane methods of studies from LAC. We evaluated the impact of the pneumococcal vaccine on hospitalization and death during or after hospitalizations due to pneumococcal disease and serotype-specific disease over time. We also analyzed the incidence of serotyped IPD in pneumococcal conjugate vaccine PCV10 and PCV13. The protocol was registered in PROSPERO (ID: CRD42023392097)., Results: 155 epidemiological studies were screened and provided epidemiological data on IPD. Meta-analysis of invasive diseases in children <5 years old found that 57%-65% of causative serotypes were included in PCV10 and 66%-84% in PCV13. After PCV introduction, vaccine serotypes declined in IPD, and the emergence of non-vaccine serotypes varied by country., Conclusions: Pneumococcal conjugate vaccines significantly reduced IPD and shifted serotype distribution in Latin America and the Caribbean. PCV10/PCV13 covered 57-84% of serotypes in children under 5, with marked decline in PCV serotypes post-vaccination. Continuous surveillance remains crucial for monitoring evolving serotypes and informing public health action., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2024 Bardach et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

Background: Streptococcus pneumoniae is a leading cause of morbidity and mortality globally, causing bacteremic pneumonia, meningitis, sepsis, and other invasive pneumococcal diseases. Evidence supports nasopharyngeal pneumococcal carriage as a reservoir for transmission and precursor of pneumococcal disease., Objectives: To estimate the pneumococcal nasopharyngeal burden in all age groups in Latin America and the Caribbean (LAC) before, during, and after the introduction of pneumococcal vaccine conjugate (PVC)., Methods: Systematic literature review of international, regional, and country-published and unpublished data, together with reports including data from serotype distribution in nasopharyngeal carriage in children and adults from LAC countries following Cochrane methods. The protocol was registered in PROSPERO database (ID: CRD42023392097)., Results: We included 54 studies with data on nasopharyngeal pneumococcal carriage and serotypes from 31,803 patients. In children under five years old, carriage was found in 41% and in adults over 65, it was 26%. During the study period, children under five showed a colonization proportion of 34% with PCV10 serotypes and 45% with PCV13 serotypes. When we analyze the carriage prevalence of PCV serotypes in all age groups between 1995 and 2019, serotypes included in PCV10 and those included in PCV13, both showed a decreasing trend along analysis by lustrum., Conclusion: The data presented in this study highlights the need to establish national surveillance programs to monitor pneumococcal nasopharyngeal carriage to monitor serotype prevalence and replacement before and after including new pneumococcal vaccines in the region. In addition, to analyze differences in the prevalence of serotypes between countries, emphasize the importance of approaches to local realities to reduce IPD effectively., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2024 Brizuela et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

Manufacturing is one of the primary sources of environmental pollution due to the emission of polluting gases and waste generation. This research aims to examine the manufacturing industry's effect on an environmental pollution index in nineteen Latin American countries using non-linear methods. The youth population, globalization, property rights, civil liberties, the unemployment gap, and government stability moderate the relationship between the two variables. The research has a temporal coverage between 1990 and 2017 and uses threshold regressions to verify the hypotheses. In order to obtain more specific inferences, we group countries according to the trade block and geographic region to which they belong. Our findings indicate that manufacturing has limited explanatory power for environmental pollution. This finding is supported by the fact that the manufacturing industry in the region is scarce. In addition, we find a threshold effect on the youth population, globalization, property rights, civil liberties, and government stability. Consequently, our results highlight the importance of institutional factors in designing and applying environmental mitigation mechanisms in developing regions., (© 2023. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

This study aims to analyze the different segments of urban tourism demand. The data were collected in Mexico City, Lima, Buenos Aires, and Bogota, and a K-means clustering method was used to find the segments. The results showed three segments: the first cluster grouped tourists interested in enjoying lodging and restaurant services; the second included visitors seeking multiple attractions, who were the most willing to recommend the destinations; finally, the third was composed of passive tourists, not drawn to the attractions of these cities. This study contributes to the literature by offering evidence of urban tourism segmentation in Latin American cities, which has been scarcely researched. Furthermore, it sheds light on this topic by finding a segment not previously described in the literature ("multiple attractions"). Finally, this study offers practical implications for managers of tourism companies to plan and improve the competitiveness of destinations based on the different segments found., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2023 Carvache-Franco et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

Anthropogenic activities are increasing the atmospheric carbon dioxide (CO 2 ); around a third of the CO 2 emitted by these activities has been taken up by the ocean. Nevertheless, this marine ecosystem service of regulation remains largely invisible to society, and not enough is known about regional differences and trends in sea-air CO 2 fluxes (FCO2), especially in the Southern Hemisphere. The objectives of this work were as follows: first to put values of FCO2 integrated over the exclusive economic zones (EEZ) of five Latin-American countries (Argentina, Brazil, Mexico, Peru, and Venezuela) into perspective regarding total country-level greenhouse gases (GHG) emissions. Second, to assess the variability of two main biological factors affecting FCO2 at marine ecological time series (METS) in these areas. FCO2 over the EEZs were estimated using the NEMO model, and GHG emissions were taken from reports to the UN Framework Convention on Climate Change. For each METS, the variability in phytoplankton biomass (indexed by chlorophyll-a concentration, Chla) and abundance of different cell sizes (phy-size) were analyzed at two time periods (2000-2015 and 2007-2015). Estimates of FCO2 at the analyzed EEZs showed high variability among each other and non-negligible values in the context of greenhouse gas emissions. The trends observed at the METS indicated, in some cases, an increase in Chla (e.g., EPEA-Argentina) and a decrease in others (e.g., IMARPE-Peru). Evidence of increasing populations of small size-phytoplankton was observed (e.g., EPEA-Argentina, Ensenada-Mexico), which would affect the carbon export to the deep ocean. These results highlight the relevance of ocean health and its ecosystem service of regulation when discussing carbon net emissions and budgets., (© 2023. The Author(s), under exclusive licence to Springer Nature Switzerland AG.)

Latin America experiences an increasing urban primacy index and a rapid expansion of the financial system, putting direct pressure on the demand for resources to satisfy the consumption of large cities. We investigate the convergence of per capita biocapacity in 16 Latin America countries and evaluate the factors that influence its evolution over time. Specifically, we analyze the impact of the urban primacy index, economic progress, and the financial globalization index on the convergence of per capita biocapacity. We use the methodological framework developed by Phillips and Sul Econometrica 75:1771-1855, (2007) to analyze the convergence and the formation of convergence clubs of biocapacity during 1970-2017. The findings indicate that the countries of the region do not share a common trend of biocapacity, although they are grouped into five converging clubs. Biocapacity transition analysis reveals that countries have heterogeneous transition pathways between them. Using marginal effects, we find that the urban primacy index and economic progress reduce the biocapacity. The effect of the financial globalization index on biocapacity is not conclusive. The quantile regressions reveal that quantiles' impact of the urban primacy index and financial globalization on per capita biocapacity is heterogeneous. However, the effect of economic progress on biocapacity that predominates among quantiles is positive. The adoption of common policies among the countries that form the converging clubs could improve the effectiveness of pro-environmental policies and promote the achievement of the Sustainable Development Goals related to environmental quality., (© 2022. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

Objective: To analyze the relationship between economic conditions and mortality in cities of Latin America. Methods: We analyzed data from 340 urban areas in ten countries: Argentina, Brazil, Chile, Colombia, Costa Rica, Guatemala, Mexico, Panama, Peru, and El Salvador. We used panel models adjusted for space-invariant and time-invariant factors to examine whether changes in area gross domestic product (GDP) per capita were associated with changes in mortality. Results: We find procyclical oscillations in mortality (i.e., higher mortality with higher GDP per capita) for total mortality, female population, populations of 0-9 and 45+ years, mortality due to cardiovascular diseases, malignant neoplasms, diabetes mellitus, respiratory infections and road traffic injuries. Homicides appear countercyclical, with higher levels at lower GDP per capita. Conclusions: Our results reveal large heterogeneity, but in our sample of cities, for specific population groups and causes of death, mortality oscillates procyclically, increasing when GDP per capita increases. In contrast we find few instances of countercyclical mortality., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2021 Leveau, Tapia Granados, Dos Santos, Castillo-Riquelme and Alazraqui.)

The ecological footprint is an indicator used in recent years to assess the accelerated process of environmental degradation experienced by countries. In particular, in regions or countries with high biodiversity, strong dependence on natural resources, high informality, and low productive specialization. We employ a set of quantitative techniques within the theoretical framework of convergence and found the existence of per capita ecological footprint clubs. In addition, we estimate a set of logistic regressions to obtain the average marginal effect of the determinants of the convergence clubs. We found that economic complexity, the shadow economy, and natural resources significantly influence the formation of convergence clubs. The results indicate the existence of convergence in three clubs, while two clubs are divergent. Environmental policymakers in this region should collectively mitigate environmental degradation and achieve sustainable development goals, particularly among the countries that make up the convergence clubs., (© 2021. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

Background: We aim in our analysis to estimate the reduction of diarrhea-related mortality rates after introduction of a rotavirus vaccine in subregions of 4 Latin American countries., Methods: We selected diarrhea-related deaths from individual-level data from death certificates in Brazil, Colombia, Ecuador, and Mexico. Counts were aggregated by region, year and month, and age group for each country. We ran an interrupted time-series analysis using Poisson regression to obtain seasonal and trend-adjusted estimates of impact. Results are reported as percentages (1 - mortality rate ratio)., Results: We found a reduction in diarrhea-related mortality in children <5 years old of 18% (95% confidence interval [CI], 15 to 20) for Mexico, 39% (95% CI, 35 to 44) for Colombia, 19 (95% CI, 17 to 22) for Brazil, and -26% (95% CI, -40 to -14) for Ecuador. Using wavelet analyses, we found a reduction of 6- and 12-month seasonality in Brazil, Colombia, and Mexico. We also found that the increased reduction of diarrhea-related deaths was larger with greater prevaccine burden of diarrhea in infants., Conclusions: Our findings and available evidence support the recommendation from the World Health Organization for the monovalent and/or pentavalent rotavirus vaccine in countries worldwide. We found an increased benefit in those settings with a higher burden of infant diarrhea-related deaths., Competing Interests: POTENTIAL CONFLICT OF INTEREST: The authors have indicated they have no potential conflicts of interest to disclose., (Copyright © 2021 by the American Academy of Pediatrics.)

Background: Worldwide, smoking tobacco causes 7 million deaths annually, and this toll is expected to increase, especially in low-income and middle-income countries. In Latin America, smoking is a leading risk factor for death and disability, contributes to poverty, and imposes an economic burden on health systems. Despite being one of the most effective measures to reduce smoking, tobacco taxation is underused and cigarettes are more affordable in Latin America than in other regions. Our aim was to estimate the tobacco-attributable burden on mortality, disease incidence, quality of life lost, and medical costs in 12 Latin American countries, and the expected health and economic effects of increasing tobacco taxes., Methods: In this modelling study, we developed a Markov probabilistic microsimulation economic model of the natural history, medical costs, and quality-of-life losses associated with the most common tobacco-related diseases in 12 countries in Latin America. Data inputs were obtained through a literature review, vital statistics, and hospital databases from each country: Argentina, Bolivia, Brazil, Chile, Colombia, Costa Rica, Ecuador, Honduras, Mexico, Paraguay, Peru, and Uruguay. The main outcomes of the model are life-years, quality-adjusted life-years, disease events, hospitalisations, disease incidence, disease cost, and healthy years of life lost. We estimated direct medical costs for each tobacco-related disease included in the model using a common costing methodology for each country. The disease burden was estimated as the difference in disease events, deaths, and associated costs between the results predicted by the model for current smoking prevalence and a hypothetical cohort of people in each country who had never smoked. The model estimates the health and financial effects of a price increase of cigarettes through taxes, in terms of disease and health-care costs averted, and increased tax revenues., Findings: In the 12 Latin American countries analysed, we estimated that smoking is responsible for approximately 345 000 (12%) of the total 2 860 921 adult deaths, 2·21 million disease events, 8·77 million healthy years of life lost, and $26·9 billion in direct medical costs annually. Health-care costs attributable to smoking were estimated to represent 6·9% of the health budgets of these countries, equivalent to 0·6% of their gross domestic product. Tax revenues from cigarette sales cover 36·0% of the estimated health expenditures caused by smoking. We estimated that a 50% increase in cigarette price through taxation would avert more than 300 000 deaths, 1·3 million disease events, gain 9 million healthy life-years, and save $26·7 billion in health-care costs in the next 10 years, with a total economic benefit of $43·7 billion., Interpretation: Smoking represents a substantial health and economic burden in these 12 countries of Latin America. Tobacco tax increases could successfully avert deaths and disability, reduce health-care spending, and increase tax revenues, resulting in large net economic benefits., Funding: International Development Research Centre (IDRC), Canada., (Copyright © 2020 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 license. Published by Elsevier Ltd.. All rights reserved.)

The present study aimed to examine the nutritional deprivation of Paraguayan households (measured as households' access to diverse diets) and investigate the association between nutritional deprivation and socio-economic characteristics in a large sample. An extension of Alkire-Foster methodology, a technique widely employed in multidimensional poverty measurement, was used to calculate both the incidence and intensity of nutritional deprivation. The resulting Nutritional Deprivation Index allows us to consider minimum food group requirements that vary by food groups as well as by individual characteristics such as age, sex and activity level. Applying the methodology to a nationally representative sample of households from the 2011-2012 Income and Expenditures Household Survey, the study found that about two in every three Paraguayan households (67 %) were inadequately nourished in at least four (of the total of six) food groups. Although no significant differences were found between rural and urban households, the incidence of multi-dimensionally deprived households generally decreased as income increased. Logistic regression results showed that nutritional deprivation decreased as household income and mother's education increased and increased with household size. Our study concludes that the majority of Paraguayan households is significantly nutritionally deprived across most food groups and suggests that strategies are needed to improve their access to diverse diets, especially among its lower- and middle-income segments., (© The Author(s) 2020.)

Background: Scientific journals play a critical role in research validation and dissemination and are increasingly vocal about the identification of research priorities and the targeting of research results to key audiences. No new journals specialising in health policy and systems research (HPSR) and focusing in the developing world or in a specific developing world region have been established since the early 1980s. This paper compares the growth of publications on HPSR across Latin America and the world and explores the potential, feasibility and challenges of innovative publication strategies., Methods: A bibliometric analysis was undertaken using HPSR MeSH terms with journals indexed in Medline. A survey was undertaken among 2500 authors publishing on HPSR in Latin America (LA) through an online survey, with a 13.1% response rate. Aggregate indicators were constructed and validated, and two-way ANOVA tests were performed on key variables., Results: HPSR publications on LA observed an average annual growth of 27.5% from the years 2000 to 2018, as against 11.4% worldwide and yet a lag on papers published per capita. A total of 48 journals with an Impact Factor publish HPSR on LA, of which 5 non-specialised journals are published in the region and are ranked in the bottom quintile of Impact Factor. While the majority of HPSR papers worldwide is published in specialised HPSR journals, in LA this is the minority. Very few researchers from LA sit in the Editorial Board of international journals. Researchers highly support strengthening quality HPSR publications through publishing in open access, on-line journals with a focus on the LA region and with peer reviewers specialized on the region. Researchers would support a new open access journal specializing in the LA region and in HPSR, publishing in English. Open access up-front costs and disincentives while waiting for an Impact Factor can be overcome., Conclusion: Researchers publishing on HPSR in LA widely support the launching of a new specialised journal for the region with a vigorous editorial policy focusing on regional and country priorities. Strategies should be in place to support English-language publishing and to develop a community of practice around the publication process. In the first years, special issues should be promoted through a priority-setting process to attract prominent authors, develop the audience and attain an Impact Factor.

Background: Latin American and Caribbean populations include three main ethnic groups: indigenous people, people of African descent, and people of European descent. We investigated ethnic inequalities among these groups in population coverage with reproductive, maternal, newborn, and child health interventions., Methods: We analysed 16 standardised, nationally representative surveys carried out from 2004 to 2015 in Latin America and the Caribbean that provided information on ethnicity or a proxy indicator (household language or skin colour) and on coverage of reproductive, maternal, newborn, and child health interventions. We selected four outcomes: coverage with modern contraception, antenatal care coverage (defined as four or more antenatal visits), and skilled attendants at birth for women aged 15-49 years; and coverage with three doses of diphtheria-pertussis-tetanus (DPT3) vaccine among children aged 12-23 months. We classified women and children as indigenous, of African descent, or other ancestry (reference group) on the basis of their self-reported ethnicity or language. Mediating variables included wealth quintiles (based on household asset indices), woman's education, and urban-rural residence. We calculated crude and adjusted coverage ratios using Poisson regression., Findings: Ethnic gaps in coverage varied substantially from country to country. In most countries, coverage with modern contraception (median coverage ratio 0·82, IQR 0·66-0·92), antenatal care (0·86, 0·75-0·94), and skilled birth attendants (0·75, 0·68-0·92) was lower among indigenous women than in the reference group. Only three countries (Nicaragua, Panama, and Paraguay) showed significant gaps in DPT3 coverage between the indigenous and the reference groups. The differences were attenuated but persisted after adjustment for wealth, education, and residence. Women and children of African descent showed similar coverage to the reference group in most countries., Interpretation: The lower coverage levels for indigenous women are pervasive, and cannot be explained solely by differences in wealth, education, or residence. Interventions delivered at community level-such as vaccines-show less inequality than those requiring access to services, such as birth attendance. Regular monitoring of ethnic inequalities is essential to evaluate existing initiatives aimed at the inclusion of minorities and to plan effective multisectoral policies and programmes., Funding: The Bill & Melinda Gates Foundation (through the Countdown to 2030 initiative) and the Wellcome Trust., (Copyright © 2018 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 license. Published by Elsevier Ltd.. All rights reserved.)

In terms of economics, implementing generic drug policy is nothing other than consolidating (or even, creating) drug markets that set competitive prices, the result of which favors public access to essential drugs. This article approaches the topic of generic drugs from the economic perspective by examining various regulatory models in order to evaluate and leverage generic drug policy implementation options as a mechanism for battling some of the markets' specific weaknesses. The conclusion is that there is no single unequivocal method for promoting the use of generic drugs, and that the most favorable way to integrate markets may be through a broad combination of alternatives. These alternatives are grouped and analyzed according to the market issues or challenges that must be overcome. Several options are then identified based on the degree of market consolidation to be obtained.

Drug supply strategies have not been widely included in Latin American health reform programs. National efforts, when they have included such strategies, have focused on supporting drug availability for inpatient treatment and, in some cases, for ambulatory treatment of low prevalence and high-cost diseases. Nevertheless, some innovative drug supply programs for primary health care have been implemented in many countries. This article reviews and systematizes recent experiences with the supply of drugs in Latin American countries. Firstly, this article analyzes four phases of the cycle for managing drugs: selection, procurement, distribution, and use, and; secondly, it identifies lessons learned and some characteristics of efficient drug supply systems. Conclusions emphasize experiences which have not only achieved supply at low costs, but also have increased the productivity, efficiency, and effectiveness of primary health care, improved prescriptions, and strengthened the network.

This paper identifies the trends and recent progress in the generation and reproduction of knowledge on health economic evaluation. Analysis is organized along nine public health action fields, namely: health determinants and predictors, economic value of health, healthcare demand, healthcare supply, microeconomic evaluation of healthcare, healthcare market balance, evaluation of policy instruments, general evaluation of the health system, and healthcare planning, regulation and supervision. Each action field is defined to place the reader in the proper setting and level of analysis. In addition, thematic research topics developed in each action field are proposed and discussed. The generation and reproduction of knowledge on the different action fields was based on the review of the bibliographic databases MEDLINE and LILACS for the 1992-2000 period. Results lead to the conclusion that development and application of economic evaluation of healthcare has been uneven across different countries and that there is a growing increase of applications starting in 1994, the year of initiation of healthcare reform in Latin America.