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Little is known about the role of WhatsApp in spreading misinformation during the start of the COVID-19 pandemic in Mexico. The aim of this study is to analyze the message content, format, authorship, time trends and social media distribution channels of misinformation in WhatsApp messages in Mexico. From March 18 to June 30, 2020 the authors collected all WhatsApp messages received via their personal contacts and their social networks that contained information about COVID-19. Descriptive and inferential statistics were used to analyze the scientifically inaccurate messages and the relationship between variables, respectively. Google image and video searches were carried out to identify sharing on other social media. Out of a total of 106 messages, the most frequently mentioned COVID-19 related message topics were prevention (20.0%), conspiracy (18.5%), therapy (15.4%) and origin of the virus (10.3%), changing throughout the pandemic according to users’ concerns. Half of all WhatsApp messages were either images or videos. WhatsApp images were also shared on Facebook (80%) and YouTube (~50%). Our findings indicate that the design of information and health promotion campaigns requires to be proactive in adapting to the changes in message content and format of misinformation shared through encrypted social media.

To analyse the relevance and quality of the research proposals submitted to the 2016 call for proposals for the initiative Improving Programme Implementation through Embedded Research (iPIER-2016) to address current public health challenges in Latin America and the Caribbean.We performed a cross-sectional study using information from 108 research proposals using quantitative and qualitative methods. We used three frameworks to analyse the relevance of the proposals: The Global Burden of Disease, the WHO Health Systems Conceptual Framework and the Sustainable Development Goals proposed in 2015 by the United Nations. We performed an index to analyse the relevance and quality of the proposals.Twenty seven percent of the proposals have very good relevance, one third of the proposals have quality flaws. This means their research questions are not related to implementation research or their methods are insufficient or inadequate to respond to the objective.The response to this call is proof of health authorities' interest in research as a tool to improve the implementation of health programs in the region. However, proposals show important variations in terms of relevance and quality among countries and training health staff in programme implementation seems a central requirement.

This article describes the main models for embedding research and the successful experiences and challenges faced in joint work by researchers and decisionmakers who participated in the Embedding Research for the Sustainable Development Goals (ER-SDG) initiative, and the experience of the Technical Support Center. In June 2018, funding was granted to 13 pre-selected research projects from 11 middle- and low-income countries in Latin America and the Caribbean (Argentina, Bolivia, Brazil, Colombia, Dominican Republic, Ecuador, Guatemala, Guyana, Haiti, Paraguay, and Peru). The projects focused on the system-, policy-, or program-level changes required to improve health and build on the joint work of researchers and decisionmakers, with a view to bringing together evidence production and decision-making in health systems and services. The Technical Support Center supported and guided the production of quality results useful for decision-making. This experience confirmed the value of initiatives such as ER-SDG in consolidating bridges between research on the implementation of health policies, programs, and systems, and the officials responsible for operating health-related programs, services, and interventions. It highlighted the importance of both respecting and taking advantage of each context-and the specific arrangements and patterns in the relationships between researchers and decisionmakers-through incentives for embedded research.En este artículo se describen los principales modelos de integración, las experiencias de éxito y los retos del trabajo conjunto de los investigadores y los tomadores de decisiones participantes en la iniciativa Incorporación de la Investigación para Avanzar en el Cumplimiento de los Objetivos de Desarrollo Sostenible (ER-SDG), y la experiencia del Centro de Apoyo Técnico (CAT). En junio de 2018 se otorgó financiamiento, previa selección, a 13 proyectos de investigación de 11 países de ingresos medios y bajos de América Latina y el Caribe (Argentina, Bolivia, Brasil, Colombia, Ecuador, Guatemala, Guyana, Haití, Paraguay, Perú y República Dominicana). Los proyectos debían estar centrados en los cambios que se requieren a nivel de sistema, políticas o programas para mejorar la salud y basarse en el trabajo conjunto de investigadores y tomadores de decisiones, a fin de acercar la generación de evidencias a la toma de decisiones en los sistemas y servicios de salud. El CAT apoyó y orientó la producción de resultados de calidad y de utilidad para la toma de decisiones. La experiencia confirmó el valor de iniciativas como ER-SDG en la consolidación de puentes entre el mundo de la investigación sobre implementación de políticas, programas y sistemas de salud, y el mundo de los funcionarios encargados de operar esos programas, servicios e intervenciones relacionadas con la salud. Se resalta la necesidad de respetar y aprovechar cada contexto, y los arreglos y patrones específicos de relación entre investigadores y tomadores de decisiones, mediante incentivos para la integración.Neste artigo são descritos os principais modelos de integração, as experiências de êxito e os desafios do trabalho conjunto de pesquisadores e responsáveis por tomar decisões que participam da iniciativa Incorporação da Pesquisa para Avançar no Cumprimento dos Objetivos de Desenvolvimento Sustentável (

Construct and evaluate the care cascade for pulmonary tuberculosis in the indigenous population of the department of Cauca (Colombia) and identify existing gaps.Mixed-methods sequential explanatory design. In the first phase, the pulmonary tuberculosis care cascade for the indigenous population of Cauca was evaluated. Data were obtained from secondary sources and all cases diagnosed from 1 January 2016 to 31 December 2017 were included. In the second phase, semi-structured interviews were done with nine program coordinators and 11 nursing auxiliaries to explain identified gaps. Absolute and percentage values were estimated for each of the steps and gaps in the care cascade. Quantitative and qualitative results were triangulated.In 2016 and 2017, an estimated 202 patients with respiratory symptoms were expected to be positive and 106 cases of pulmonary tuberculosis were reported among the indigenous population of the department of Cauca. A gap of 47.5% was found for diagnosis, since only 52.5% of subjects were diagnosed in health services. This gap was explained by poor quality of samples and flawed smear techniques; flaws in correct identification of patients with respiratory symptoms; limited access to diagnostic methods, such as culture and molecular tests; and limited training and high turnover of personnel in health service provider institutions.The tuberculosis control program should focus actions on bridging the gap in case detection in the indigenous population.Construir y evaluar la cascada de atención de la tuberculosis pulmonar en la población indígena del departamento del Cauca (Colombia) e identificar las brechas existentes.Metodología mixta con diseño secuencial explicativo. En la primera fase se evaluó la cascada de atención de la tuberculosis pulmonar para la población indígena del Cauca. Se obtuvieron datos de fuentes secundarias y se incluyeron todos los casos diagnosticados entre el 1 de enero del 2016 y el 31 de diciembre de 2017. En la segunda fase, se aplicaron entrevistas semiestructuradas a nueve coordinadores de programa y 11 auxiliares de enfermería para explicar las brechas identificadas. Se estimaron los valores absolutos y porcentuales en cada uno de los pasos y las brechas de la cascada de atención. Se triangularon los resultados cuantitativos y cualitativos.Durante 2016 y 2017 se estimaron 202 sintomáticos respiratorios esperados positivos y se notificaron 106 casos de tuberculosis pulmonar en la población indígena del departamento del Cauca. Se encontró una brecha de 47,5% para el diagnóstico, ya que solo 52,5% de los sujetos recibieron el diagnóstico en los servicios de salud. Las explicaciones a esta brecha fueron la mala calidad de muestras y fallas en la técnica del extendido, fallas en la correcta identificación del sintomático respiratorio, acceso limitado a métodos diagnósticos como cultivo y pruebas moleculares, así como capacitación escasa y rotación alta de personal al interior de las instituciones prestadoras de servicios de salud.Las acciones del programa de control de tuberculosis deben enfocarse en reducir la brecha de detección de casos en la población indígena.Elaborar e avaliar a cascata de atenção da tuberculose pulmonar na população indígena do Departamento de Cauca (Colômbia) e identificar as lacunas existentes.Metodologia mista com desenho sequencial explicativo. Na primeira fase, avaliamos a cascata de atenção da tuberculose pulmonar para a população indígena de Cauca. Os dados foram obtidos de fontes secundárias, incluindo todos os casos diagnosticados entre 1 de janeiro de 2016 e 31 de dezembro de 2017. Na segunda fase, realizamos entrevistas semiestruturadas com nove coordenadores do programa e 11 auxiliares de enfermagem para explicar as lacunas identificadas. Estimamos os valores absolutos e percentuais em cada uma das etapas e as lacunas na cascata de atenção. Os resultados quantitativos e qualitativos foram triangulados.Nos anos de 2016 e 2017, foi estimada a ocorrência de 202 casos com sintomas respiratórios com diagnóstico esperado positivo; no entanto, os serviços de saúde só diagnosticaram e notificaram 106 casos de tuberculose pulmonar na população indígena do Departamento de Cauca. Portanto, identificamos uma lacuna diagnóstica de 47,5%, já que apenas 52,5% dos casos receberam um diagnóstico nos serviços de saúde. As explicações para esta lacuna foram a má qualidade das amostras e falhas na técnica de esfregaço, falhas na identificação correta dos sintomas respiratórios, acesso limitado aos métodos de diagnóstico, tais como cultura e testes moleculares, bem como capacitação deficiente e alta rotatividade de pessoal nas instituições de saúde.As ações do programa de controle da tuberculose devem se concentrar em reduzir a lacuna na detecção de casos na população indígena.

Recent literature uses different terms and approaches to the collaboration between researchers and health system decision-makers in the research process. In 2012, the World Health Organisation proposed to "Embed research within decision-making processes". Yet, important contributions use other terms and perspectives for the same issue. This scoping review aimed to identify these terms, approaches, their application and eventual influence on the utilization of evidence.We searched papers published between January 2000 and February 2019 in English, Spanish, French and Portuguese in the databases of PubMed, Scielo, Google Scholar and EBSCOhost, thus accessing MedicLatina, MEDLINE Complete and eBook Collection. Our main inclusion criterion was the participation of health personnel in non-clinical research activities. We considered three domains for in depth analysis: Definition, name and description of the participation of decision makers and health staff; Forms of collaboration and actual/effective participation of health staff in research; Eventual influence on the utilization of research results.We identified 607 articles and selected 74 for full text analysis. Nineteen different terms are currently used in twelve countries to describe the participation of health decision-makers and staff in research activities. Most publications refer to Integrated Knowledge Translation or Embedded Research, and were published in Canada and the United Kingdom. Forty-five papers discuss the participation of health staff in research activities; 20 leading the whole process and 21 as collaborators.The identification of the different terms and approaches to the close collaboration of health staff and decision-makers with professional researchers is essential to promote its effective application and influence on the utilization of evidence. Yet, it is also necessary to insist in their co-participation throughout the whole investigation process as a relevant way to improve research results uptake, strengthen health systems and advance towards universal health coverage.

This study aims to evaluate, via a mixed methods study, the implementation of the screening process for pulmonary tuberculosis (PTB) within indigenous population of the Department of Cauca, Colombia, during the 2016-2018 period. Indicators assessing the PTB screening process were elaborated and estimated. Subsequently, an evaluation of the indicators were performed based on a sampling process from health care providers of the municipalities with the highest and lowest PTB incidence and from key agents’ perspective. Screening indicators were estimated and thematic analysis was performed based on the interviews conducted with key agents. Finally, a triangulation of quantitative and qualitative findings was performed. From the total population expected to have respiratory symptomatics (n = 16,711), the health care providers were able to identify 42.3% of them. Out of the individuals identified as respiratory symptomatics (n = 7,064), they were able to examine 93.2% (n = 6,585) with at least one acid-fast bacilli smear test. The reported positivity index from acid-fast bacilli smear test was 1.87%. The explanations from key agents revolved around the possibility of an overestimated targeted amount of respiratory symptomatics; insufficient personnel for the search of symptomatic individuals; high costs for the search in areas of difficult access; the need to request permissions from indigenous authorities; culturally ingrained stigma; use of traditional medicine and self-medication; and patient’s personal beliefs. This study revealed barriers in the implementation of the screening process for PTB within the indigenous population from the Department of Cauca, mainly in the identifying process of the respiratory symptomatics. El objetivo fue evaluar la implementación del proceso y los indicadores en las pruebas para detectar tuberculosis pulmonar (TBP) en población indígena del Departamento de Cauca, Colombia, durante el periodo de 2016-2018, a través de un estudio de métodos mixtos. Fueron elaborados y estimados indicadores para el tamizaje de TBP. Posteriormente, a través de un proceso de muestreo de los proveedores de cuidados de salud de las municipalidades con las incidencias más altas y más bajas de TBP, y desde la perspectiva de actores clave, se intentó encontrar una explicación para los resultados de la primera fase. Se estimaron los indicadores de las pruebas y se realizó un análisis temático de las entrevistas dirigidas a los actores clave. Finalmente, se realizó la triangulación de los hallazgos cuantitativos y cualitativos. Del total de sintomáticos respiratorios esperados (n = 16.711), los proveedores de servicios de salud fueron capaces de identificar a un 42,3% de ellos, y de estos sintomáticos respiratorios identificados (n = 7.064) fueron capaces de examinar un 93,2% (n = 6.585) con al menos una prueba de frotis de bacilos ácidorresistentes. El índice de positividad informado en la prueba de la flema analizada en el microscopio, mediante la prueba de frotis de bacilos ácidorresistentes, fue 1.87%. Las explicaciones de los actores clave giraron alrededor de la percepción de un objetivo posiblemente sobreestimado de sintomáticos respiratorios; insuficiente personal para la consulta; altos costes para las consultas en áreas geográficas de difícil acceso; solicitud de permisos a las autoridades indígenas; estigma; medicina tradicional, automedicación y creencias. Este estudio reveló barreras en la implementación de las pruebas para la TBP en la población indígena del Departamento de Cauca, principalmente en el proceso de identificación de sintomáticos respiratorios. O estudo teve como objetivo avaliar a implementação do processo e os indicadores de triagem para tuberculose pulmonar (TBP) numa população indígena do Departamento de Cauca, Colômbia, no período 2016-2018. Foi realizado um estudo com métodos mistos. Foram elaborados e estimados os indicadores para triagem da TBP. Em seguida, procurou-se explicar os achados da primeira fase, com base em um processo de amostragem de provedores de saúde dos municípios com os coeficientes mais altos e mais baixos de incidência de TBP, e da perspectiva dos atores-chave. Os indicadores de triagem foram estimados e a análise foi realizada das entrevistas com os atores-chave. Finalmente, foi feita a triangulação dos achados quantitativos e qualitativos. Do total de sintomáticos respiratórios esperados (n = 16.711), o provedor de saúde conseguiu identificar 42,3%, e destes sintomáticos respiratórios identificados (n = 7.064) conseguiram examinar 93,2% (n = 6.585) com pelo menos um exame de escarro (teste de BAAR). O índice de positividade do teste de BAAR foi de 1,87%. As explicações dos atores chave giraram em torno da percepção de uma proporção possivelmente superestimada de sintomáticos respiratórios, pessoal insuficiente para a busca, custos elevados da busca em áreas de difícil acesso geográfico, solicitação de autorização pelas autoridades indígenas, estigma, medicina tradicional, automedicação e crenças. O estudo revelou barreiras para a implementação da triagem para TBP na população indígena do Departamento de Cauca, principalmente no processo de identificação de sintomáticos respiratórios.

Background It is estimated, there are around 370 million indigenous people in the world. For 2017, 5.4% of tuberculosis cases in Colombia occurred in the indigenous population (IP), while in the Cauca region, it was 32% and only 19.3% of new cases were detected. This is the second region with the highest proportion of IP in Colombia. This could affect the fulfillment of the aims of the Colombian Strategic Plan Towards the End of TB. Our aim was to evaluate the pulmonary tuberculosis (PTB) care cascade in IP of Cauca and identified gaps in the cascade. Methods Mixed methods (explanatory sequential desing). In the quantitative phase, the care cascade was evaluated. In the qualitative phase we sought to explain the gaps in the cascade. Tuberculosis program information and semi-structured interviews were used. Results In the care cascade in IP, 202 cases of presumptive PTB (New smear-positive expected) were estimated. A gap of undiagnosed cases of 47.5% was found (n = 96). This gap was explained by poor quality of the Acid-Fast Bacillus Smear, failures in the identification of presumptive tuberculosis, limited access to diagnostic methods, poor training and high turnover of healthcare workers were identified as possible explanations. Conclusions The efforts of the tuberculosis control program in the IP should focus on reducing the gap of undiagnosed cases. Key messages The PTB in IP could affect the fulfillment of the goals of the program. Approximately half of the expected cases were not detected during 2016-2017.

BackgroundEpisiotomy in Mexico is highly prevalent and often routine - performed in up to 95% of births to primiparous women. The WHO suggests that episiotomy be used in selective cases, with an expected prevalence of 15%. Training programs to date have been unsuccessful in changing this practice. This research aims to understand how and why this practice persists despite shifts in knowledge and attitudes facilitated by the implementation of an obstetric training program.MethodsThis is a descriptive and interpretative qualitative study. We conducted 53 pre and post-intervention (PRONTO© Program) semi-structured interviews with general physician, gynecologists and nurses (N = 32, 56% women). Thematic analysis was carried out using Atlas-ti© software to iteratively organize codes. Through interpretive triangulation, the team found theoretical saturation and explanatory depth on key analytical categories.ResultsThemes fell into five major themes surrounding their perceptions of episiotomy: as a preventive measure, as a procedure that resolves problems in the moment, as a practice that gives the clinician control, as a risky practice, and the role of social norms in practicing it. Results show contradictory discourses among professionals. Despite the growing support for the selective use of episiotomy, it remains positively perceived as an effective prophylaxis for the complications of childbirth while maintaining control in the hands of health care providers.ConclusionsPerceptions of episiotomy shed light on how and why routine episiotomy persists, and provides insight into the multi-faceted approaches that will be required to affect this harmful obstetrical practice.

OBJECTIVE: To assess the determinants of embedded implementation research (EIR) conduct in seven Latin American and Caribbean countries. METHODS: This qualitative interpretative study conducted and analyzed 14 semi-structured interviews based on a grounded theory approach using Atlas-ti© 7.5.7. We grouped the conditions appointed by interviewees as determinants of EIR conduct into six domains. RESULTS: The participation of high-level engaged decision makers as research co-producers is an important EIR determinant that fosters research use. Nevertheless, EIR faces challenges such as dealing with key personnel changes and fluctuating political contexts. CONCLUSIONS: Despite its limitations, EIR is effective in creating a sense of ownership of research results among implementers, which helps bridge the gap between research and decision-making in health system

To assess the process and outcomes of the implementation of an electronic fingerprint initiative as part of quality improvement in three health facilities in the Northern Department of Haiti, in terms of its acceptability, adoption, feasibility, fidelity, and sustainability. In Haiti, poor attendance of the healthcare workforce is a nationwide problem, closely related to the quality of care. Three health institutions have tried to implement an electronic fingerprint system to monitor and improve attendance.An exploratory and qualitative descriptive study of the implementation outcomes of the fingerprint initiative. It was based on semi-structured interviews and one group discussion using purposeful sampling techniques to recruit participants, and an open coding system and deductive approach to analyze the data using ATLAS.ti 8.The fingerprint initiative was successfully implemented in a non-governmental organization supported health facility but, despite some planning, it was never implemented in the public health facilities. The acceptability of the implementation was high in the not-for-profit organization and low in the public settings, mostly in relation to the presence of champions and the leadership at each health facility.We recommend more involvement of the leadership of health facilities in the different phases of the implementation process in order to guarantee acceptability, adoption, fidelity and sustainabiliy. More research is needed to articulate this technology-driven initiative in the Haitian health system.Evaluar el proceso y los resultados de la puesta en práctica de una iniciativa de digitalización de huellas dactilares como parte de la mejora de la calidad en tres establecimientos de salud del departamento Norte de Haití, en cuanto a su aceptabilidad, adopción, viabilidad, fidelidad y sostenibilidad. En Haití, el absentismo de los trabajadores de atención de salud es un problema nacional, estrechamente relacionado con la calidad de la atención. Tres instituciones de salud han tratado de poner en práctica un sistema de huellas dactilares digitalizadas para monitorear y mejorar la asistencia.Se ha llevado a cabo un estudio descriptivo cualitativo y exploratorio de los resultados de la puesta en práctica de la iniciativa de la huella dactilar. Este estudio empleó entrevistas semiestructuradas y una discusión de grupo mediante técnicas de muestreo con fines específicos para reclutar a los participantes, y un sistema de codificación abierta y enfoque deductivo para analizar los datos con ATLAS.ti 8.La iniciativa de la huella dactilar se llevó a cabo satisfactoriamente en un establecimiento de salud no gubernamental; sin embargo, a pesar de cierta planificación, no llegó a ponerse en práctica en establecimientos públicos de salud. La aceptabilidad de la implementación fue alta en las organizaciones sin fines de lucro y baja en los entornos públicos, principalmente en lo que respecta a la presencia de líderes y dirigentes en cada establecimiento de salud.Recomendamos una mayor participación de la gerencia de los establecimientos de salud en las diferentes fases del proceso de ejecución para garantizar aceptabilidad, adopción, fidelidad y sostenibilidad. Se necesita investigación adicional para integrar esta iniciativa impulsada por la tecnología en el sistema de salud haitiano.Avaliar o processo e os resultados da implantação de uma iniciativa de controle de ponto eletrônico por biometria para melhoria da qualidade em três serviços de saúde no Departamento Norte do Haiti quanto à aceitabilidade, adoção, viabilidade, fidelidade e sustentabilidade. A baixa assiduidade no trabalho do pessoal da saúde é um problema em todo o país e está estreitamente relacionada à qualidade da atenção. Foi feita uma tentativa de implantar um sistema de ponto eletrônico por biometria em três instituições de saúde, para monitorar e aumentar a assiduidade no trabalho.Estudo exploratório, descritivo e qualitativo dos resultados da implantação da iniciativa de ponto eletrônico por biometria. Os dados foram coletados em entrevistas semiestruturadas e em um grupo de discussão usando técnica de amostragem intencional para recrutar os participantes. A análise de dados foi realizada por codificação aberta e enfoque dedutivo com o uso do software ATLAS.ti 8.A iniciativa de ponto eletrônico por biometria foi implantada com êxito em um serviço de saúde apoiado por uma organização não governamental. Porém, apesar do planejamento, ela nunca foi implantada nos serviços da rede pública. A aceitabilidade foi muito boa na entidade sem fins lucrativos, mas foi baixa na rede pública, sobretudo em relação à presença de apoiadores e dirigentes no local.Recomenda-se maior envolvimento dos dirigentes dos serviços de saúde nas diferentes fases do processo de implantação para garantir a aceitabilidade, adoção, fidelidade e sustentabilidade da iniciativa. Mais pesquisas são necessárias para estruturar esta iniciativa com uso de tecnologia no sistema de saúde do Haiti.

This article describes the main models for embedding research and the successful experiences and challenges faced in joint work by researchers and decisionmakers who participated in the Embedding Research for the Sustainable Development Goals (ER-SDG) initiative, and the experience of the Technical Support Center. In June 2018, funding was granted to 13 pre-selected research projects from 11 middle- and low-income countries in Latin America and the Caribbean (Argentina, Bolivia, Brazil, Colombia, Dominican Republic, Ecuador, Guatemala, Guyana, Haiti, Paraguay, and Peru). The projects focused on the system-, policy-, or program-level changes required to improve health and build on the joint work of researchers and decisionmakers, with a view to bringing together evidence production and decision-making in health systems and services. The Technical Support Center supported and guided the production of quality results useful for decision-making. This experience confirmed the value of initiatives such as ER-SDG in consolidating bridges between research on the implementation of health policies, programs, and systems, and the officials responsible for operating health-related programs, services, and interventions. It highlighted the importance of both respecting and taking advantage of each context-and the specific arrangements and patterns in the relationships between researchers and decisionmakers-through incentives for embedded research.Neste artigo são descritos os principais modelos de integração, as experiências de êxito e os desafios do trabalho conjunto de pesquisadores e responsáveis por tomar decisões que participam da iniciativa Incorporação da Pesquisa para Avançar no Cumprimento dos Objetivos de Desenvolvimento Sustentável (

Construct and evaluate the care cascade for pulmonary tuberculosis in the indigenous population of the department of Cauca (Colombia) and identify existing gaps.Mixed-methods sequential explanatory design. In the first phase, the pulmonary tuberculosis care cascade for the indigenous population of Cauca was evaluated. Data were obtained from secondary sources and all cases diagnosed from 1 January 2016 to 31 December 2017 were included. In the second phase, semi-structured interviews were done with nine program coordinators and 11 nursing auxiliaries to explain identified gaps. Absolute and percentage values were estimated for each of the steps and gaps in the care cascade. Quantitative and qualitative results were triangulated.In 2016 and 2017, an estimated 202 patients with respiratory symptoms were expected to be positive and 106 cases of pulmonary tuberculosis were reported among the indigenous population of the department of Cauca. A gap of 47.5% was found for diagnosis, since only 52.5% of subjects were diagnosed in health services. This gap was explained by poor quality of samples and flawed smear techniques; flaws in correct identification of patients with respiratory symptoms; limited access to diagnostic methods, such as culture and molecular tests; and limited training and high turnover of personnel in health service provider institutions.The tuberculosis control program should focus actions on bridging the gap in case detection in the indigenous population.Elaborar e avaliar a cascata de atenção da tuberculose pulmonar na população indígena do Departamento de Cauca (Colômbia) e identificar as lacunas existentes.Metodologia mista com desenho sequencial explicativo. Na primeira fase, avaliamos a cascata de atenção da tuberculose pulmonar para a população indígena de Cauca. Os dados foram obtidos de fontes secundárias, incluindo todos os casos diagnosticados entre 1 de janeiro de 2016 e 31 de dezembro de 2017. Na segunda fase, realizamos entrevistas semiestruturadas com nove coordenadores do programa e 11 auxiliares de enfermagem para explicar as lacunas identificadas. Estimamos os valores absolutos e percentuais em cada uma das etapas e as lacunas na cascata de atenção. Os resultados quantitativos e qualitativos foram triangulados.Nos anos de 2016 e 2017, foi estimada a ocorrência de 202 casos com sintomas respiratórios com diagnóstico esperado positivo; no entanto, os serviços de saúde só diagnosticaram e notificaram 106 casos de tuberculose pulmonar na população indígena do Departamento de Cauca. Portanto, identificamos uma lacuna diagnóstica de 47,5%, já que apenas 52,5% dos casos receberam um diagnóstico nos serviços de saúde. As explicações para esta lacuna foram a má qualidade das amostras e falhas na técnica de esfregaço, falhas na identificação correta dos sintomas respiratórios, acesso limitado aos métodos de diagnóstico, tais como cultura e testes moleculares, bem como capacitação deficiente e alta rotatividade de pessoal nas instituições de saúde.As ações do programa de controle da tuberculose devem se concentrar em reduzir a lacuna na detecção de casos na população indígena.

OBJECTIVE To assess the quality of adolescent friendly health services. METHODS Qualitative assessment using the simulated user technique in first level clinics of Health Services of Morelos, Mexico, during 2018. Ten out of 17 facilities with non-exclusive adolescent friendly services were randomly selected. An additional facility with exclusive adolescent friendly services was included as an intensive subsample. Four adolescents served as simulated users interpreting different cases in the clinics. The total of 43 semi-structured exit interviews were conducted, and two nominal groups were made to assess the perceived quality from the adolescents’ perception of friendliness and experience. Thematic analysis of the data obtained was performed. RESULTS Staff attitude was highlighted as a key element in the adolescents’ experience. Failures were found, such as the existence of bureaucratic barriers to access, lack of signage in clinics, lack of privacy and confidentiality, failure of physical examination during the appointment and lack of monitoring of the reasons for appointment. The exclusive clinic for adolescents offered more appropriate friendly services compared with nonexclusive clinics. CONCLUSION Although the service is accessible in most of the clinics visited, it is still far from being friendly according to international recommendations. The exclusive clinic for adolescents stood out for having better structured mechanisms that can be implemented in nonexclusive clinics to improve the care process. RESUMEN OBJETIVO Evaluar la calidad de los servicios de salud amigables para adolescentes. MÉTODOS Evaluación cualitativa utilizando la técnica de usuario simulado en clínicas de primer nivel de los Servicios de Salud de Morelos, México durante 2018. Se seleccionaron aleatoriamente 10 de 17 establecimientos con servicios amigables no exclusivos para adolescentes. Se incluyó adicionalmente un centro con servicios amigables exclusivo para adolescentes como submuestra de tipo intensivo. Cuatro adolescentes fungieron como usuarios simulados interpretando diferentes casos de consulta en las clínicas. Se realizaron 43 entrevistas semiestructuradas de salida y se hicieron dos grupos nominales para evaluar la calidad percibida a partir de la percepción de amigabilidad y la experiencia de los adolescentes. Se realizó análisis temático de los datos obtenidos. RESULTADOS La actitud del personal destacó como un elemento clave para la experiencia de los adolescentes. Se encontraron fallas como la existencia de barreras burocráticas para el acceso, falta de señalamientos en las clínicas, falta de privacidad y confidencialidad, fallas en la exploración física durante la consulta y falta de seguimiento de los motivos de consulta. La clínica exclusiva para adolescentes ofreció servicios amigables más adecuados en comparación con las clínicas no exclusivas. CONCLUSIÓN Aunque en la mayoría de los establecimientos visitados el servicio es accesible, aun distan de cumplir con las características de amigabilidad de acuerdo con las recomendaciones internacionales. La clínica exclusiva para adolescentes destacó al contar con mecanismos mejor estructurados que pueden ser implementados en clínicas no exclusivas para mejorar el proceso de atención.

To evaluate the results of educational interven- tion on health and safety regarding principles of biosafety in cleaning workers of a health institution.Using concurrent mixed methods, we evaluated a total of 31 workers on their knowledge, attitudes, and practices of biosafety and risk perception. We conducted baseline measurements and two follow-ups. Fractional logistic regression models were fitted with study stage as covariate. Additional models included interactions of study stage with key workers characteristics. Thematic qualitative analysis and triangulation was developed.The knowledge (+33.3 points, scale 0-100), attitudes (+10.6), and practices (+23.5) increased significantly in the first follow-up; knowledge de- creased in the second follow-up (p0.001). The qualitative findings revealed an improvement in risk prevention attitudes and practices, framed by experiences of vulnerability, stigma, and discrimination.The study provides key elements for biosafety research related to vulnerable groups and it is effective in promoting the health of a disadvantaged and invisible sector.Evaluar los resultados de una intervención educativa sobre salud y seguridad laboral bajo principios de bioseguridad en trabajadores y trabajadoras de limpieza de una institución de salud.Evaluación con métodos mixtos concurrentes sobre conocimientos, actitudes y prácticas en bioseguridad y percepción de riesgos, con medición basal y dos seguimientos, en 31 trabajadores y trabajadoras. Se realizaron modelos fraccionales separados para estimar interacciones de las mediciones. Se hizo análisis cualitativo temático y triangulación metodológica.Los conocimientos (+33.3 puntos, escala 0 - 100), actitudes (+10.6) y prácticas (+23.5) incrementaron signifi- cativamente en el primer seguimiento; los conocimientos disminuyeron en el segundo seguimiento (p0.001). Los ha- llazgos cualitativos revelaron mejora en actitudes y prácticas de prevención frente al riesgo, enmarcados por experiencias de vulnerabilidad, estigma y discriminación.El estudio aporta elementos clave para la investigación en bioseguridad relacionada con grupos vulnerables y es efectivo para la promoción de la salud de un sector desfavorecido e invisibilizado.

Objetivo. Estimar la desigualdad en acceso a servicios de salud en poblaciones de localidades menores de 100 000 habitantes en México. Material y métodos. Análisis de la Encuesta Nacional de Salud y Nutrición 100k 2018. Se estimó el acceso con base en la afiliación a un esquema de aseguramiento (acceso potencial) y la atención para el más reciente problema de salud (acceso a atención) mediante el índice de concentración, utilizando una imputación del ingreso per cápita. Resultados. La afiliación a algún esquema de ase­guramiento en salud fue de 82.42% y el acceso a atención de 60.03%. Se identificaron desigualdades en ambos indicadores, marginales para acceso potencial y con mayor concentración entre la población de menor ingreso; para acceso a atención se encontró desigualdad con mayor concentración entre la población de mayor ingreso. Conclusión. En México pre­valecen desigualdades en acceso a servicios de salud para la población en condiciones de pobreza. Es necesario desarrollar intervenciones públicas con mayor granularidad para incidir de forma efectiva en la desigualdad.

Objetivo. Describir la situación de salud y nutrición de la población mexicana que habita en localidades de menos de 100 000 habitantes (100k) para el año 2018 y compararla con una muestra con características similares en 2012. Material y métodos. Se presentan los resultados sobre la salud y nutrición de la población más relevantes analizados en 19 artículos sobre el acceso y utilización de los servicios de salud, la situación de salud y nutrición por grupos de edad y sobre los hogares afectados por inseguridad alimentaria. Resultados. Se obtuvo información de salud y nutrición a nivel nacional en población de localidades

Introduction Family planning (FP) is one of the key services provided by health care systems. Extending beyond matters of sexual and reproductive health, its area of influence impacts directly on the development of individuals and nations. After 60 years of intense FP activities in Mexico, and in light of recent restructuring of health service supply and financing, services need to be assessed from a user perspective. Objective Based on a comprehensive conceptual framework, this article assesses the quality of the FP services provided by the Mexican Ministry of Health (MoH). Analysis considers not only accessibility and availability but also the users' perceptions of the care process, particularly as regards the interpersonal relations they experience with staff and the type of information they are provided. Material and methods This study used a descriptive, qualitative design based on maximum variation sampling in six Mexican states. It included visits to 12 clinics in urban and rural areas. Thematic analysis was performed on 86 semi-structured interviews administered to FP service users. Results While access was described by users as "easy," their experiences revealed normalized barriers. One of our key findings referred to inverse availability, meaning that the contraceptive methods available were generally not the ones preferred by users, with their selection therefore being shaped by shortage of supplies. Challenges included disrespect for the free choice of FP users and coercion during consultations for contraception post obstetric event. Finally, information provided to users left considerable room for improvement. Conclusions After six decades of FP service supply, results indicate a series of quality issues that may lie at the heart of the unmet demand reported in the literature. Based on a comprehensive conceptual scheme, the present study analyzes the quality of services, highlighting areas for improvement that should be considered by the MoH in future efforts.

Objetivo. Evaluar los resultados de una intervención educativa sobre salud y seguridad laboral bajo principios de bioseguridad en trabajadores y trabajadoras de limpieza de una institución de salud. Material y métodos. Evaluación con métodos mixtos concurrentes sobre conocimientos, actitudes y prácticas en bioseguridad y percepción de riesgos, con medición basal y dos seguimientos, en 31 trabajadores y trabajadoras. Se realizaron modelos fraccionales separados para estimar interacciones de las mediciones. Se hizo análisis cualitativo temático y triangulación metodológica. Resul­tados. Los conocimientos (+33.3 puntos, escala 0 - 100), actitudes (+10.6) y prácticas (+23.5) incrementaron signifi­cativamente en el primer seguimiento; los conocimientos disminuyeron en el segundo seguimiento (p

To identify and analyze the factors associated with the decision of migrants suffering violence while in transit through Mexico, to continue on their trip or turn back. Cross-sectional study combining quantitative and qualitative analyses. Socio-demographic and health characteristics, as well as types of violence and factors associated with the decision to continue on the trip, were explored for 862 migrants. 35 migrants were interviewed to explore their perceptions of migration, socioeconomic and political situations in their countries of origin, risks, violence experienced, and the decision to continue on their trip. Of the 862 migrants, 21.1% experienced violence during their transit through Mexico towards the USA. Of these, 88.5% decided to continue on their journey. This decision was positively associated with age (OR = 1.075, p < 0.05), number of children (OR = 3.161, p < 0.10), homicide rate in the country of origin (OR = 1.043, p < 0.10) and proximity to the northern border. No differences were observed by sex, schooling, days in transit and the presence of health problems. The decision to continue the journey to the United States was related to structural factors in the countries of origin, rather than risks in transit. It is necessary to implement mechanisms to promote and protect the human rights of migrants during their whole journey (origin, transit and destination).

Estudio cualitativo que explora percepciones del uso de condón en relación con las ITS/VIH de jóvenes mexicanos migrantes y no migrantes a los Estados Unidos. Realizamos 40 entrevistas a profundidad a hombres y mujeres de 15 a 24 años de edad en dos municipios de México. Indagamos respecto a la construcción social de la sexualidad, la percepción del riesgo y la vulnerabilidad, en relación con el uso del condón e ITS. Los hallazgos indican que la percepción de riesgo se expresa mediante el concepto “quién es quién”, que refleja procesos sociales de confianza y control, generando tipologías de parejas que podrían contribuir al riesgo y vulnerabilidad de los jóvenes y las jóvenes frente a ITS/VIH.

OBJECTIVE: To test acceptability and reliability of audio computer-assisted self-interviewing (ACASI) system administered at the household level to gather data on risk behaviors among adolescents in Mexico. METHODS: Answers to sensitive behavior-related questions obtained using ACASI systems were compared with answers to the same questions obtained through face-to-face interviews (FFIs). Focus groups were conducted to explore ACASI acceptability among adolescents and its feasibility in obtaining better self-reported data on sensitive behaviors. RESULTS: ACASI was adolescents' preferred method for reporting risk behaviors, particularly sexual behavior, and did not pose greater challenges to respondents versus FFIs. Also, more risk behaviors were reported through ACASI versus FFIs. CONCLUSION: The use of ACASI systems in disadvantaged households to obtain data on adolescent risk behavior is not only feasible but may also improve data quality in the case of complex questionnaires, compared with FFIs, and should therefore be considered as an alternative survey method.OBJETIVO: Evaluar la aceptabilidad y fiabilidad de un sistema de autoentrevista asistido por audio y computadora (ACASI) aplicado en los hogares para recopilar información sobre el comportamiento de riesgo de los adolescentes en México. MÉTODOS: Se compararon las respuestas obtenidas mediante el sistema ACASI y entrevistas cara a cara (FFI) sobre aspectos sensibles del comportamiento. Se analizó en grupos focales la aceptabilidad de ACASI para los adolescentes y la factibilidad de obtener mejor información en los autoinformes sobre aspectos sensibles de su conducta. RESULTADOS: Los adolescentes prefirieron el sistema ACASI para informar sobre conductas de riesgo, en particular las relacionadas con el sexo, y no constituyó un mayor reto para los entrevistados en comparación con las FFI. Se informaron más comportamientos de riesgo mediante ACASI que en las FFI. CONCLUSIONES: El empleo del sistema ACASI para obtener información sobre las conductas de riesgo de adolescentes en hogares con dificultades económicas no solo es factible, sino que en el caso de cuestionarios complejos puede mejorar la calidad de la información en comparación con las FFI y debe considerarse como un método alternativo de encuesta.

BackgroundIn 2007, a non-contributory pension program was launched in rural areas of Mexico. The program consisted in a non-conditional cash transfer of US$40 monthly to all older adults (OA) aged 70 and over. We evaluate the effect of the program on mental well-being of its beneficiaries.Methods and findingsQuantitative and qualitative methods were used. For the quantitative component, we used the selection criteria established by the program (age and locality size) to form the Intervention (OA aged 70-74 residing in rural localities, ResultsAfter a year of exposure, the program had a significant effect on reduction of depressive symptoms (β = -0.06, CI95% -0.12; -0.01) and an increase in empowerment indicators: OA participated in important household decisions (β = 0.09, CI95% 0.03;0.15); and OA participated in household decisions pertaining to expenses (β = 0.11, CI95% 0.05;0.18). Qualitative analysis found a strong trend showing a reduction of sadness, and feeling of increasing empowerment.ConclusionsThese results suggest that a non-conditional transfer in older ages have an impact beyond the economic sphere, impacting even the mental well-being. This effect could be explained because the pension produces feelings of safety and welfare. It is recommendable that governments should invest efforts towards universalizing the non-contributory pension programs in order to ensure a basic income for the elderly.

Introduction Mexico faces important problems concerning income and health inequity. Mexico’s national public agenda prioritizes remedying current inequities between its indigenous and non-indigenous population groups. This study explores the changes in social inequalities among Mexico’s indigenous and non-indigenous populations for the time period 2000 to 2010 using routinely collected poverty, welfare and health indicator data. Methods We described changes in socioeconomic indicators (housing condition), poverty (Foster-Greer-Thorbecke and Sen-Shorrocks-Sen indexes), health indicators (childhood stunting and infant mortality) using diverse sources of nationally representative data. Results This analysis provides consistent evidence of disparities in the Mexican indigenous population regarding both basic and crucial developmental indicators. Although developmental indicators have improved among the indigenous population, when we compare indigenous and non-indigenous people, the gap in socio-economic and developmental indicators persists. Conclusions Despite a decade of efforts to promote public programs, poverty persists and is a particular burden for indigenous populations within Mexican society. In light of the results, it would be advisable to review public policy and to specifically target future policy to the needs of the indigenous population.