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2. Impact of the Salud Mesoamerica Initiative on delivery care choices in Guatemala, Honduras, and Nicaragua

Author

Hernandez, Bernardo, Harris, Katie Panhorst, Johanns, Casey K., Palmisano, Erin B., Cogen, Rebecca, Thom, Maximilian G., Linebarger, Emily, El Bcheraoui, Charbel, Kamath, Aruna M., Camarda, Joseph, Rios-Zertuche, Diego, Zúñiga-Brenes, María Paola, Bernal-Lara, Pedro, Colombara, Danny, Schaefer, Alexandra, Salvatierra, Benito, Mateus, Julio César, Casas, Isabel, Flores, Giovanni, Iriarte, Emma, and Mokdad, Ali H.

Published
2022
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4. Performance of passive case detection for malaria surveillance: results from nine countries in Mesoamerica and the Dominican Republic

Author

Rios-Zertuche, Diego, Carter, Keith H., Harris, Katie Panhorst, Thom, Max, Zúñiga-Brenes, Maria Paola, Bernal-Lara, Pedro, González-Marmol, Álvaro, Johanns, Casey K., Hernández, Bernardo, Palmisano, Erin, Cogen, Rebecca, Naik, Paulami, El Bcheraoui, Charbel, Smith, David L., Mokdad, Ali H., and Iriarte, Emma

Published
2021
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12. Additional file 1 of Impact of the Salud Mesoamerica Initiative on delivery care choices in Guatemala, Honduras, and Nicaragua

Author

Hernandez, Bernardo, Harris, Katie Panhorst, Johanns, Casey K., Palmisano, Erin B., Cogen, Rebecca, Thom, Maximilian G., Linebarger, Emily, El Bcheraoui, Charbel, Kamath, Aruna M., Camarda, Joseph, Rios-Zertuche, Diego, Z����iga-Brenes, Mar��a Paola, Bernal-Lara, Pedro, Colombara, Danny, Schaefer, Alexandra, Salvatierra, Benito, Mateus, Julio C��sar, Casas, Isabel, Flores, Giovanni, Iriarte, Emma, and Mokdad, Ali H.

Abstract

Additional file 1: Supplemental Table 1. Additional characteristics of women at baseline in intervention and comparison groups, overall and by country. Supplemental Table 2. Characteristics of women at follow-up in intervention and comparison groups, overall and by country. Supplemental Table 3. Unweighted OLS models predicting facility score, overall and by country. Supplemental Table 4. Results of medical record review of uncomplicated deliveries in the last 2 years at baseline and follow-up for intervention and comparison groups by country. Supplemental Table 5. Reasons for not delivering in facility at baseline and follow-up in intervention and comparison groups by country.

Published
2022
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13. Additional file 1 of Performance of passive case detection for malaria surveillance: results from nine countries in Mesoamerica and the Dominican Republic

Author

Rios-Zertuche, Diego, Carter, Keith H., Harris, Katie Panhorst, Thom, Max, Zúñiga-Brenes, Maria Paola, Bernal-Lara, Pedro, González-Marmol, Álvaro, Johanns, Casey K., Hernández, Bernardo, Palmisano, Erin, Cogen, Rebecca, Paulami Naik, Bcheraoui, Charbel El, Smith, David L., Mokdad, Ali H., and Iriarte, Emma

Abstract

Additional file 1. List of diagnoses to select medical records.

Published
2021
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15. Methods to measure quality of care and quality indicators through health facility surveys in low- and middle-income countries

Author

Rios-Zertuche, Diego, Zúñiga-Brenes, Paola, Palmisano, Erin, Hernández, Bernardo, Schaefer, Alexandra, Johanns, Casey K, Gonzalez-Marmol, Alvaro, Mokdad, Ali H, and Iriarte, Emma

Subjects
health facility surveys, Quality Assurance, Health Care, Salud Mesoamerica Initiative, Infant, Newborn, Central America, Prenatal Care, performance measures, quality metrics, clinical quality, Editor's Choice, Contraception, quality of care, Pregnancy, Methods Article, Humans, Female, Infant Health, Maternal Health Services, Health Facilities, Child, Developing Countries
Abstract

Objective Present methods to measure standardized, replicable and comparable metrics to measure quality of medical care in low- and middle-income countries. Design We constructed quality indicators for maternal, neonatal and child care. To minimize reviewer judgment, we transformed criteria from check-lists into data points and decisions into conditional algorithms. Distinct criteria were established for each facility level and type of care. Indicators were linked to discharge diagnoses. We designed electronic abstraction tools using computer-assisted personal interviewing software. Setting We present results for data collected in the poorest areas of Belize, Costa Rica, El Salvador, Guatemala, Honduras, Nicaragua, Panama and the state of Chiapas in Mexico (January—October 2014). Results We collected data from 12 662 medical records. Indicators show variations of quality of care between and within countries. Routine interventions, such as quality antenatal care (ANC), immediate neonatal care and postpartum contraception, had low levels of compliance. Records that complied with quality ANC ranged from 68.8% [confidence interval (CI):64.5–72.9] in Costa Rica to 5.7% [CI:4.0–8.0] in Guatemala. Less than 25% of obstetric and neonatal complications were managed according to standards in all countries. Conclusions Our study underscores that, with adequate resources and technical expertise, collecting data for quality indicators at scale in low- and middle-income countries is possible. Our indicators offer a comparable, replicable and standardized framework to identify variations on quality of care. The indicators and methods described are highly transferable and could be used to measure quality of care in other countries.

Published
2018

17. Adolescent health in the Eastern Mediterranean Region : findings from the global burden of disease 2015 study

Author

Mokdad, Ali H, Azzopardi, Peter, Cini, Karly, Kennedy, Elissa, Sawyer, Susan, El Bcheraoui, Charbel, Charara, Raghid, Khalil, Ibrahim, Moradi-Lakeh, Maziar, Collison, Michael, Afifi, Rima A, Al-Raiby, Jamela, Krohn, Kristopher J, Daoud, Farah, Chew, Adrienne, Afshin, Ashkan, Foreman, Kyle J, Kassebaum, Nicholas J, Kutz, Michael, Kyu, Hmwe H, Liu, Patrick, Olsen, Helen E, Smith, Alison, Stanaway, Jeffrey D, Wang, Haidong, Arnlov, Johan, Kiadaliri, Aliasghar Ahmad, Alam, Khurshid, Alasfoor, Deena, Ali, Raghib, Alizadeh-Navaei, Reza, Al-Raddadi, Rajaa, Altirkawi, Khalid A, Alvis-Guzman, Nelson, Anber, Nahla, Antonio, Carl Abelardo T, Anwari, Palwasha, Artaman, Al, Asayesh, Hamid, Barker-Collo, Suzanne L, Bedi, Neeraj, Beghi, Ettore, Bennett, Derrick A, Bensenor, Isabela M, Bhutta, Zulfiqar A, Butt, Zahid A, Castaneda-Orjuela, Carlos A, Catala-Lopez, Ferran, Charlson, Fiona J, Danawi, Hadi, De Leo, Diego, Degenhardt, Louisa, Denno, Donna, Deribe, Kebede, Jarlais, Don C Des, Dey, Subhojit, Dharmaratne, Samath D, Djalalinia, Shirin, Erskine, Holly E, Fereshtehnejad, Seyed-Mohammad, Ferrari, Alize J, Fischer, Florian, Gebrehiwot, Tsegaye Tewelde, Geleijnse, Johanna M, Gona, Philimon N, Gugnani, Harish Chander, Gupta, Rajeev, Hamadeh, Randah Ribhi, Hamidi, Samer, Maria Haro, Josep, Hay, Roderick J, Hearps, Stephen JC, Hendrie, Delia, Hotez, Peter J, Hu, Guoqing, Jonas, Jost B, Karch, Andre, Karimi, Seyed M, Kasaeian, Amir, Kebede, Seifu, Kengne, Andre Pascal, Khan, Ejaz Ahmad, Khosravi, Ardeshir, Khubchandani, Jagdish, Kokubo, Yoshihiro, Kopec, Jacek A, Kosen, Soewarta, Larson, Heidi J, Larsson, Anders, Leasher, Janet L, Leung, Janni, Li, Yongmei, Lotufo, Paulo A, Lunevicius, Raimundas, Abd El Razek, Hassan Magdy, Majdzadeh, Reza, Majeed, Azeem, Memiah, Peter, Memish, Ziad A, Mendoza, Walter, Mhimbira, Francis Apolinary, Miller, Ted R, Mitchell, Philip B, Monasta, Lorenzo, Obermeyer, Carla Makhlouf, Oh, In-Hwan, Olusanya, Bolajoko Olubukunola, Ortiz, Alberto, Park, Eun-Kee, Parry, Matti, Pereira, David M, Phillips, Michael Robert, Pourmalek, Farshad, Qorbani, Mostafa, Radfar, Amir, Rafay, Anwar, Rahimi-Movaghar, Vafa, Rai, Rajesh Kumar, Rana, Saleem M, Rawaf, David Laith, Rawaf, Salman, Reavley, Nicola, Renzaho, Andre MN, Rezaei, Satar, Sadegh-Rezai, Mohammad, Rios-Zertuche, Diego, Roshandel, Gholamreza, Rothenbacher, Dietrich, Safdarian, Mahdi, Safi, Sare, Safiri, Saeid, Sahraian, Mohammad Ali, Salamati, Payman, Samy, Abdallah M, Sanabria, Juan Ramon, Santomauro, Damian, Sartorius, Benn, Schwebel, David C, Seedat, Soraya, Sepanlou, Sadaf G, Setegn, Tesfaye, Shaheen, Amira, Shaikh, Masood Ali, Shiri, Rahman, Sigfusdottir, Inga Dora, Singh, Jasvinder A, Sobaih, Badr HA, Sreeramareddy, Chandrashekhar T, Abdulkader, Rizwan Suliankatchi, Tehrani-Banihashemi, Arash, Temsah, Mohamad-Hani, Terkawi, Abdullah Sulieman, Thomson, Alan J, Tonelli, Marcello, Topor-Madry, Roman, Tran, Bach Xuan, Ukwaja, Kingsley Nnanna, Uthman, Olalekan A, Vasankari, Tommi, Venketasubramanian, Narayanaswamy, Vlassov, Vasiliy Victorovich, Vollset, Stein Emil, Weiderpass, Elisabete, Weintraub, Robert G, Werdecker, Andrea, Whiteford, Harvey A, Yano, Yuichiro, Yaseri, Mehdi, Yonemoto, Naohiro, Younis, Mustafa Z, Yu, Chuanhua, Jumaan, Aisha O, Vos, Theo, Hay, Simon I, Naghavi, Mohsen, Patton, George C, Murray, Christopher JL, Reg, GBD 2015 Eastern Mediterranean, Helmholtz-Zentrum für Infektionsforschung GmbH, Inhoffenstr. 7, 38124 Braunschweig, Germany., Department of Public Health, Secure Systems research group / N. Asokan, and Clinicum

Subjects
Male, Health (social science), Nutrition and Disease, Laboratory of Virology, Poison control, Adolescent health, 030204 cardiovascular system & hematology, Global Health, Occupational safety and health, Global Burden of Disease, Disasters, 0302 clinical medicine, Risk Factors, Voeding en Ziekte, Prevalence, Global health, 030212 general & internal medicine, Child, education.field_of_study, Middle East, Mediterranean Region, Mental Disorders, Smoking, 1. No poverty, Burden of disease, Public Health, Global Health, Social Medicine and Epidemiology, MEDITERRÂNEO, 3142 Public health care science, environmental and occupational health, 3. Good health, Contraception, 1117 Public Health And Health Services, OBESITY, Original Article, Female, Public Health, medicine.medical_specialty, Adolescent, Population, OS Groenvoorziening, Developing country, Communicable Diseases, Eastern Mediterranean Region, Laboratorium voor Virologie, Young Adult, 03 medical and health sciences, FUTURE, Environmental health, SYSTEMATIC ANALYSIS, medicine, Humans, Noncommunicable Diseases, education, VLAG, Public health, Public Health, Environmental and Occupational Health, Klinisk medicin, Overweight, Folkhälsovetenskap, global hälsa, socialmedicin och epidemiologi, RISK-FACTORS, INJURIES, Morbidity, Clinical Medicine
Abstract

Objectives The 22 countries of the East Mediterranean Region (EMR) have large populations of adolescents aged 10–24 years. These adolescents are central to assuring the health, development, and peace of this region. We described their health needs. Methods Using data from the Global Burden of Disease Study 2015 (GBD 2015), we report the leading causes of mortality and morbidity for adolescents in the EMR from 1990 to 2015. We also report the prevalence of key health risk behaviors and determinants. Results Communicable diseases and the health consequences of natural disasters reduced substantially between 1990 and 2015. However, these gains have largely been offset by the health impacts of war and the emergence of non-communicable diseases (including mental health disorders), unintentional injury, and self-harm. Tobacco smoking and high body mass were common health risks amongst adolescents. Additionally, many EMR countries had high rates of adolescent pregnancy and unmet need for contraception. Conclusions Even with the return of peace and security, adolescents will have a persisting poor health profile that will pose a barrier to socioeconomic growth and development of the EMR. Electronic supplementary material The online version of this article (doi:10.1007/s00038-017-1003-4) contains supplementary material, which is available to authorized users.

Published
2018

18. Adolescent health in the Eastern Mediterranean Region : findings from the global burden of disease 2015 study

Author

Mokdad, Ali H., Azzopardi, Peter, Cini, Karly, Kennedy, Elissa, Sawyer, Susan, El Bcheraoui, Charbel, Charara, Raghid, Khalil, Ibrahim, Moradi-Lakeh, Maziar, Collison, Michael, Afifi, Rima A., Al-Raiby, Jamela, Krohn, Kristopher J., Daoud, Farah, Chew, Adrienne, Afshin, Ashkan, Foreman, Kyle J., Kassebaum, Nicholas J., Kutz, Michael, Kyu, Hmwe H., Liu, Patrick, Olsen, Helen E., Smith, Alison, Stanaway, Jeffrey D., Wang, Haidong, Arnlov, Johan, Kiadaliri, Aliasghar Ahmad, Alam, Khurshid, Alasfoor, Deena, Ali, Raghib, Alizadeh-Navaei, Reza, Al-Raddadi, Rajaa, Altirkawi, Khalid A., Alvis-Guzman, Nelson, Anber, Nahla, Antonio, Carl Abelardo T., Anwari, Palwasha, Artaman, Al, Asayesh, Hamid, Barker-Collo, Suzanne L., Bedi, Neeraj, Beghi, Ettore, Bennett, Derrick A., Bensenor, Isabela M., Bhutta, Zulfiqar A., Butt, Zahid A., Castaneda-Orjuela, Carlos A., Catala-Lopez, Ferran, Charlson, Fiona J., Danawi, Hadi, De Leo, Diego, Degenhardt, Louisa, Denno, Donna, Deribe, Kebede, Jarlais, Don C. Des, Dey, Subhojit, Dharmaratne, Samath D., Djalalinia, Shirin, Erskine, Holly E., Fereshtehnejad, Seyed-Mohammad, Ferrari, Alize J., Fischer, Florian, Gebrehiwot, Tsegaye Tewelde, Geleijnse, Johanna M., Gona, Philimon N., Gugnani, Harish Chander, Gupta, Rajeev, Hamadeh, Randah Ribhi, Hamidi, Samer, Maria Haro, Josep, Hay, Roderick J., Hearps, Stephen J. C., Hendrie, Delia, Hotez, Peter J., Hu, Guoqing, Jonas, Jost B., Karch, Andre, Karimi, Seyed M., Kasaeian, Amir, Kebede, Seifu, Kengne, Andre Pascal, Khan, Ejaz Ahmad, Khosravi, Ardeshir, Khubchandani, Jagdish, Kokubo, Yoshihiro, Kopec, Jacek A., Kosen, Soewarta, Larson, Heidi J., Larsson, Anders, Leasher, Janet L., Leung, Janni, Li, Yongmei, Lotufo, Paulo A., Lunevicius, Raimundas, Abd El Razek, Hassan Magdy, Majdzadeh, Reza, Majeed, Azeem, Memiah, Peter, Memish, Ziad A., Mendoza, Walter, Mhimbira, Francis Apolinary, Miller, Ted R., Mitchell, Philip B., Monasta, Lorenzo, Obermeyer, Carla Makhlouf, Oh, In-Hwan, Olusanya, Bolajoko Olubukunola, Ortiz, Alberto, Park, Eun-Kee, Parry, Matti, Pereira, David M., Phillips, Michael Robert, Pourmalek, Farshad, Qorbani, Mostafa, Radfar, Amir, Rafay, Anwar, Rahimi-Movaghar, Vafa, Rai, Rajesh Kumar, Rana, Saleem M., Rawaf, David Laith, Rawaf, Salman, Reavley, Nicola, Renzaho, Andre M. N., Rezaei, Satar, Sadegh-Rezai, Mohammad, Rios-Zertuche, Diego, Roshandel, Gholamreza, Rothenbacher, Dietrich, Safdarian, Mahdi, Safi, Sare, Safiri, Saeid, Sahraian, Mohammad Ali, Salamati, Payman, Samy, Abdallah M., Sanabria, Juan Ramon, Santomauro, Damian, Sartorius, Benn, Schwebel, David C., Seedat, Soraya, Sepanlou, Sadaf G., Setegn, Tesfaye, Shaheen, Amira, Shaikh, Masood Ali, Shiri, Rahman, Sigfusdottir, Inga Dora, Singh, Jasvinder A., Sobaih, Badr H. A., Sreeramareddy, Chandrashekhar T., Abdulkader, Rizwan Suliankatchi, Tehrani-Banihashemi, Arash, Temsah, Mohamad-Hani, Terkawi, Abdullah Sulieman, Thomson, Alan J., Tonelli, Marcello, Topor-Madry, Roman, Tran, Bach Xuan, Ukwaja, Kingsley Nnanna, Uthman, Olalekan A., Vasankari, Tommi, Venketasubramanian, Narayanaswamy, Vlassov, Vasiliy Victorovich, Vollset, Stein Emil, Weiderpass, Elisabete, Weintraub, Robert G., Werdecker, Andrea, Whiteford, Harvey A., Yano, Yuichiro, Yaseri, Mehdi, Yonemoto, Naohiro, Younis, Mustafa Z., Yu, Chuanhua, Jumaan, Aisha O., Vos, Theo, Hay, Simon I., Naghavi, Mohsen, Patton, George C., Murray, Christopher J. L., Mokdad, Ali H., Azzopardi, Peter, Cini, Karly, Kennedy, Elissa, Sawyer, Susan, El Bcheraoui, Charbel, Charara, Raghid, Khalil, Ibrahim, Moradi-Lakeh, Maziar, Collison, Michael, Afifi, Rima A., Al-Raiby, Jamela, Krohn, Kristopher J., Daoud, Farah, Chew, Adrienne, Afshin, Ashkan, Foreman, Kyle J., Kassebaum, Nicholas J., Kutz, Michael, Kyu, Hmwe H., Liu, Patrick, Olsen, Helen E., Smith, Alison, Stanaway, Jeffrey D., Wang, Haidong, Arnlov, Johan, Kiadaliri, Aliasghar Ahmad, Alam, Khurshid, Alasfoor, Deena, Ali, Raghib, Alizadeh-Navaei, Reza, Al-Raddadi, Rajaa, Altirkawi, Khalid A., Alvis-Guzman, Nelson, Anber, Nahla, Antonio, Carl Abelardo T., Anwari, Palwasha, Artaman, Al, Asayesh, Hamid, Barker-Collo, Suzanne L., Bedi, Neeraj, Beghi, Ettore, Bennett, Derrick A., Bensenor, Isabela M., Bhutta, Zulfiqar A., Butt, Zahid A., Castaneda-Orjuela, Carlos A., Catala-Lopez, Ferran, Charlson, Fiona J., Danawi, Hadi, De Leo, Diego, Degenhardt, Louisa, Denno, Donna, Deribe, Kebede, Jarlais, Don C. Des, Dey, Subhojit, Dharmaratne, Samath D., Djalalinia, Shirin, Erskine, Holly E., Fereshtehnejad, Seyed-Mohammad, Ferrari, Alize J., Fischer, Florian, Gebrehiwot, Tsegaye Tewelde, Geleijnse, Johanna M., Gona, Philimon N., Gugnani, Harish Chander, Gupta, Rajeev, Hamadeh, Randah Ribhi, Hamidi, Samer, Maria Haro, Josep, Hay, Roderick J., Hearps, Stephen J. C., Hendrie, Delia, Hotez, Peter J., Hu, Guoqing, Jonas, Jost B., Karch, Andre, Karimi, Seyed M., Kasaeian, Amir, Kebede, Seifu, Kengne, Andre Pascal, Khan, Ejaz Ahmad, Khosravi, Ardeshir, Khubchandani, Jagdish, Kokubo, Yoshihiro, Kopec, Jacek A., Kosen, Soewarta, Larson, Heidi J., Larsson, Anders, Leasher, Janet L., Leung, Janni, Li, Yongmei, Lotufo, Paulo A., Lunevicius, Raimundas, Abd El Razek, Hassan Magdy, Majdzadeh, Reza, Majeed, Azeem, Memiah, Peter, Memish, Ziad A., Mendoza, Walter, Mhimbira, Francis Apolinary, Miller, Ted R., Mitchell, Philip B., Monasta, Lorenzo, Obermeyer, Carla Makhlouf, Oh, In-Hwan, Olusanya, Bolajoko Olubukunola, Ortiz, Alberto, Park, Eun-Kee, Parry, Matti, Pereira, David M., Phillips, Michael Robert, Pourmalek, Farshad, Qorbani, Mostafa, Radfar, Amir, Rafay, Anwar, Rahimi-Movaghar, Vafa, Rai, Rajesh Kumar, Rana, Saleem M., Rawaf, David Laith, Rawaf, Salman, Reavley, Nicola, Renzaho, Andre M. N., Rezaei, Satar, Sadegh-Rezai, Mohammad, Rios-Zertuche, Diego, Roshandel, Gholamreza, Rothenbacher, Dietrich, Safdarian, Mahdi, Safi, Sare, Safiri, Saeid, Sahraian, Mohammad Ali, Salamati, Payman, Samy, Abdallah M., Sanabria, Juan Ramon, Santomauro, Damian, Sartorius, Benn, Schwebel, David C., Seedat, Soraya, Sepanlou, Sadaf G., Setegn, Tesfaye, Shaheen, Amira, Shaikh, Masood Ali, Shiri, Rahman, Sigfusdottir, Inga Dora, Singh, Jasvinder A., Sobaih, Badr H. A., Sreeramareddy, Chandrashekhar T., Abdulkader, Rizwan Suliankatchi, Tehrani-Banihashemi, Arash, Temsah, Mohamad-Hani, Terkawi, Abdullah Sulieman, Thomson, Alan J., Tonelli, Marcello, Topor-Madry, Roman, Tran, Bach Xuan, Ukwaja, Kingsley Nnanna, Uthman, Olalekan A., Vasankari, Tommi, Venketasubramanian, Narayanaswamy, Vlassov, Vasiliy Victorovich, Vollset, Stein Emil, Weiderpass, Elisabete, Weintraub, Robert G., Werdecker, Andrea, Whiteford, Harvey A., Yano, Yuichiro, Yaseri, Mehdi, Yonemoto, Naohiro, Younis, Mustafa Z., Yu, Chuanhua, Jumaan, Aisha O., Vos, Theo, Hay, Simon I., Naghavi, Mohsen, Patton, George C., and Murray, Christopher J. L.

Abstract

The 22 countries of the East Mediterranean Region (EMR) have large populations of adolescents aged 10-24 years. These adolescents are central to assuring the health, development, and peace of this region. We described their health needs. Using data from the Global Burden of Disease Study 2015 (GBD 2015), we report the leading causes of mortality and morbidity for adolescents in the EMR from 1990 to 2015. We also report the prevalence of key health risk behaviors and determinants. Communicable diseases and the health consequences of natural disasters reduced substantially between 1990 and 2015. However, these gains have largely been offset by the health impacts of war and the emergence of non-communicable diseases (including mental health disorders), unintentional injury, and self-harm. Tobacco smoking and high body mass were common health risks amongst adolescents. Additionally, many EMR countries had high rates of adolescent pregnancy and unmet need for contraception. Even with the return of peace and security, adolescents will have a persisting poor health profile that will pose a barrier to socioeconomic growth and development of the EMR.

Published
2018
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21. Breastfeeding Practices among Poor Women in Mesoamerica.

Author

Colombara, Danny V., Hernández, Bernardo, Gagnier, Marielle C., Johanns, Casey, Desai, Sima S., Haakenstad, Annie, McNellan, Claire R., Palmisano, Erin B., Rios-Zertuche, Diego, Schaefer, Alexandra, Zúñiga-Brenes, Paola, Zyznieuski, Nicholas, Iriarte, Emma, and Mokdad, Ali H.

Subjects
BREASTFEEDING, CHILD mortality, CHILDREN'S health, HOUSEHOLD surveys, POOR women, NUTRITION research, HEALTH, PREVENTION, PHYSIOLOGY
Abstract

Background: Breastfeeding is an effective intervention to reduce pediatric morbidity and mortality. The prevalence of practices and predictors of breastfeeding among the poor in Mesoamerica has not been well described. Objectives: We estimated the prevalence of ever breastfeeding, early initiation of breastfeeding, exclusive breastfeeding, and breastfeeding between 6 mo and 2 y of age using household survey data for the poorest quintile of families living in 6 Mesoamerican countries. We also assessed the predictors of breastfeeding behaviors to identify factors amenable to policy interventions. Methods: We analyzed data from 12,529 children in Guatemala, Honduras, Mexico (Chiapas State), Nicaragua, Panama, and El Salvador using baseline survey data from the Salud Mesoamérica 2015 Initiative. We created multivariable Poisson regression models with robust variance estimates to calculate adjusted risk ratios (aRRs) and 95% CIs for breastfeeding outcomes and to control for sociodemographic and healthcare-related factors. Results: Approximately 97% of women inall countries breastfed their child at least once, and 65.1 % (Nicaragua) to 79.0% (Panama) continued to do so between 6 mo and 2 y of age. Breastfeeding in the first hour of life varied by country (P < 0.001), with the highest proportion reported in Panama (89.8%) and the lowest in El Salvador (65.6%). Exclusive breastfeeding also varied by country (P= 0.037), ranging from 44.5% in Panama to 76.8% in Guatemala. For every 20% increase in the proportion of peers who exclusively breastfed, there was an 11 % (aRR: 1.11, 95% CI: 1.04, 1.18) increase in the likelihood of exclusive breastfeeding. Conclusion: Our study revealed significant variation in the prevalence of breastfeeding practices by poor women across countries surveyed by the Salud Mesoamérica 2015 initiative. Future interventions to promote exclusive breastfeeding should consider ways to leverage the role of the community in supporting individual women. [ABSTRACT FROM AUTHOR]

Published
2015
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22. Coverage and timing of antenatal care among poor women in 6 Mesoamerican countries

Author

Dansereau, Emily, McNellan, Claire R., Gagnier, Marielle C., Desai, Sima S., Haakenstad, Annie, Johanns, Casey K., Palmisano, Erin B., Ríos-Zertuche, Diego, Schaefer, Alexandra, Zúñiga-Brenes, Paola, Hernandez, Bernardo, Iriarte, Emma, and Mokdad, Ali H.

Subjects
Antenatal care, Prenatal care, Coverage, Salud Mesoamérica Initiative, Skilled ANC, Household surveys
Abstract

Background: Poor women in the developing world have a heightened need for antenatal care (ANC) but are often the least likely to attend it. This study examines factors associated with the number and timing of ANC visits for poor women in Guatemala, Honduras, Mexico, Nicaragua, Panama, and El Salvador. Methods: We surveyed 8366 women regarding the ANC they attended for their most recent birth in the past two years. We conducted logistic regressions to examine demographic, household, and health characteristics associated with attending at least one skilled ANC visit, four skilled visits, and a skilled visit in the first trimester. Results: Across countries, 78 % of women attended at least one skilled ANC visit, 62 % attended at least four skilled visits, and 56 % attended a skilled visit in the first trimester. The proportion of women attending four skilled visits was highest in Nicaragua (81 %) and lowest in Guatemala (18 %) and Panama (38 %). In multiple countries, women who were unmarried, less-educated, adolescent, indigenous, had not wanted to conceive, and lacked media exposure were less likely to meet international ANC guidelines. In countries with health insurance programs, coverage was associated with attending skilled ANC, but not the timeliness. Conclusions: Despite significant policy reforms and initiatives targeting the poor, many women living in the poorest regions of Mesoamérica are not meeting ANC guidelines. Both supply and demand interventions are needed to prioritize vulnerable groups, reduce unplanned pregnancies, and reach populations not exposed to common forms of media. Top performing municipalities can inform effective practices across the region.

Published
2016
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