The role of private providers in maternal and child health and family planning services in developing countries.
This paper uses data from the Demographic and Health Surveys program (DHS) in 11 countries in Asia, Africa, and Latin America to explore the contribution of private health care providers to population coverage with a variety of maternal and child health and family planning services. The choice of countries and services assessed was mainly determined by the availability of data in the different surveys. Private providers contribute significantly to family planning services and treatment of children's infectious diseases in a number of the countries studied. This is as expected from the predictions of economic theory, since these goods are less subject to market failures. For the more 'public goods' type services, such as immunization and ante-natal care, their role is much more circumscribed. Two groups of countries were identified: those with a higher private provision role across many different types of services and those where private provision was limited to only one or two types of the services studied. The analysis identified the lack of consistent or systematic definitions of private providers across countries as well as the absence of data on many key services in most of the DHS surveys. Given the significance of private provision of public health goods in many countries, the authors propose much more systematic efforts to measure these variables in the future. This could be included in future DHS surveys without too much difficulty. (+info)
The world economic crisis. Part 1: Repercussions on health.
The widespread economic crisis has resulted in a fall in living standards in the western hemisphere of over 9% (1981-83) and in Sub-Saharan Africa they have fallen to the level of 1970. Food production in the African countries most seriously affected by drought dropped by 15% between 1981 and 1983. Living standards also fell in some countries in Europe and in some of the poorest countries of Asia. The high cost of fuel, the heavy burden of interest payments and unfavourable terms of trade in Africa and Latin America led to serious unemployment, devaluation of national currencies and formidable austerity policies. While some countries have succeeded in protecting their health services from cuts in public expenditure, in many others cuts in health budgets have been substantial. The effects of the crisis in some countries have amounted to the virtual disintegration of rural health services. There are limited data available to show what has been happening to levels of expenditure on health, but those presented here demonstrate that levels of health expenditure per head have fallen in many countries. The cumulative effects on health of increased poverty, unemployment, underemployment and famine, and the reduced capacity of health services to respond to health problems can be documented with facts for a number of countries in Latin America and Africa. Malnutrition has increased and improvements in infant mortality have been checked or reversed. The economic crisis has placed at risk the health of the most vulnerable. (+info)
Attitudes towards reproduction in Latin America. Teachings from the use of modern reproductive technologies.
The use of modern reproductive technology, such as in-vitro fertilization and its related procedures, has opened new areas of legal, religious and public concern. Thirty years ago, the development of effective methods to control procreation generated a debate on whether couples had the right to enjoy sex in the absence of its procreative effect. Today, assisted reproductive technology (ART) allows couples to have their own children in the absence of a direct intermediation of sex. The Catholic Church has reacted against both contraception and ART, and specific instructions have been directed to the public, the medical profession and legislators. In a recent survey, 88.4% of the population in Latin America claims to be Catholic; therefore, bioethical considerations and legal implications concerning intervention in reproduction are strongly permeated by the moral teachings of Catholicism. In 1996, 83 medical doctors and scientists, participating in the Latin American Network of Assisted Reproduction, produced a consensus document on ethical aspects and legal implications of ART. The document contains minimal ethical guidelines that Latin American professionals have decided to adhere to, even in the absence of legal regulations. This article examines how the medical profession, legislators and the public react to religious influence when confronted by difficult bioethical decisions such as the right to procreate. (+info)
Worldwide trends in DDT levels in human breast milk.
BACKGROUND: Concern over human breast milk contamination with the pesticide DDT (1,1,1-trichloro-2,2-bis(chlorodiphenyl)ethane) has prompted numerous studies around the world during the last five decades. This article examines trends in reported DDT levels, and the apparent effect of restrictions on DDT use. METHODS: More than 130 published values for DDT in human milk since 1951 were compiled, and trend lines were fit for regions of the world. RESULTS: Population means have declined in much of the world, from 5000-10000 microg DDT/kg milk fat to around 1000 today in many areas. Although different regions have different means, the decline seen in various countries corresponds to their restricting DDT use. DISCUSSION: DDT concentrations in human milk have declined in most areas of the world, consistent with restrictions on its use. Nevertheless, levels can be high in areas still using DDT, even higher than the World Health Organization's recommended limit for infants. These results indicate that population averages can be reduced by a predictable amount as DDT use is restricted. (+info)
Mitochondrial DNA variation among Anopheles albimanus populations.
Barriers to gene flow between Pacific and Atlantic coast populations of Anopheles albimanus were reported in an earlier study of variation in the intergenic spacer of the nuclear ribosomal DNA. We examined the distribution of mitochondrial DNA haplotypes among A. albimanus populations to test for gene flow barriers with an independent genetic marker. A region of the NADH dehydrogenase subunit 5 gene was amplified by the polymerase chain reaction (PCR) in 1,105 mosquitoes collected from 16 locations in Guatemala and in single collections from Mexico, Honduras, Nicaragua, Costa Rica, Panama, Colombia, and Venezuela. The PCR products were tested for variation using single strand conformation polymorphism analysis and 45 haplotypes were detected. Haplotype frequencies did not vary between coasts in Guatemala. Populations within approximately 200 km of one another were panmictic. However, at distances > 200 km, FST and geographic distances were correlated suggesting that populations are isolated by distance. (+info)
In vitro activities of BMS-207147 against over 600 contemporary clinical bloodstream isolates of Candida species from the SENTRY Antimicrobial Surveillance Program in North America and Latin America.
We compared the in vitro activity of BMS-207147, an investigational triazole, with those of itraconazole and fluconazole against 613 clinical bloodstream isolates of Candida spp. collected from SENTRY participating hospitals during 1997 and 1998. Overall, BMS-207147 was the most active azole against all Candida spp. While both BMS-207147 and itraconazole displayed a stepwise decrease in activity against isolates for which the fluconazole MICs were elevated, BMS-207147 had two- to fourfold greater activity than itraconazole both against Candida spp. that were dose-dependently fluconazole susceptible and against those that were fluconazole resistant. (+info)
Bioinvasions of the medfly Ceratitis capitata: source estimation using DNA sequences at multiple intron loci.
The Mediterranean fruit fly, Ceratitis capitata, is a devastating agricultural pest that threatens to become established in vulnerable areas such as California and Florida. Considerable controversy surrounds the status of Californian medfly infestations: Do they represent repeated introductions or the persistence of a resident population? Attempts to resolve this question using traditional population genetic markers and statistical methods are problematic because the most likely source populations in Latin America were themselves only recently colonized and are genetically very similar. Here, significant population structure among several New World medfly populations is demonstrated through the analysis of DNA sequence variation at four intron loci. Surprisingly, in these newly founded populations, estimates of population structure increase when measures of subdivision take into account the relatedness of alleles as well as their frequency. A nonequilibrium, likelihood-based statistical test that utilizes multilocus genotypes suggests that the sole medfly captured in California during 1996 was introduced from Latin America and was less likely to be a remnant of an ancestral Californian population. Many bioinvasions are hierarchical in nature, consisting of several sequential or overlapping invasion events, the totality of which can be termed a metainvasion. Phylogenetic data from multilocus DNA sequences will be vital to understanding the evolutionary and ecological processes that underlie metainvasions and to resolving their constituent levels. (+info)
Latin American nephrology: scientific production and impact of the publications.
BACKGROUND: During the last two decades, there has been a significant change in the origin and impact of the world's biomedical scientific production, particularly in countries in which the investment in research accounts for an important portion of the gross national product (GNP). However, in less developed countries, budget restrictions and the lack of policies toward research may determine a limited growth of the scientific production. METHODS: We examined the number and impact of peer-reviewed publications from Latin America included in the Institute of Scientific Information (ISI) and MEDLINE databases. In addition, we analyzed the number of abstracts submitted to the congresses of the International Society of Nephrology (ISN), American Society of Nephrology (ASN), and Latin American Society of Nephrology and Hypertension (SLANH). RESULTS: The number of peer-reviewed publications in nephrology from authors in Latin America during the last 20 years represented less than 1% of the world's total. Only 13 out of the 22 Latin American countries accounted for these publications. The citation impact (3.52) was below the world average (7.82). However, this index showed a tendency towards growth in the five most productive countries. Likewise, the number of abstracts submitted to international meetings of nephrology by authors in Latin American countries has shown a steady growth in the recent years, but remains proportionately low compared with the rest of the world. CONCLUSIONS: This study indicates that although efforts toward improving the quantity and quality of research in Latin America have been made, the final results are less than other regions in the world. Possible factors responsible for the low performance include a failure in academic motivation and lack of pressure for publication, as well as limited research funding. Therefore, important efforts from local and international nephrological communities are needed to boost research in Latin America. (+info)