RESUMO
OBJECTIVE: To conduct a comparative analysis of social inequalities in eye health and eye health care and generate baseline evidence for seven Latin American countries as a benchmarking exercise for monitoring progress toward three goals of the regional Plan of Action for the Prevention of Blindness and Visual Impairment: increasing eye health service coverage, minimizing barriers, and reducing eye health-related disease burden. METHODS: Results from cross-sectional eye health surveys conducted in six Latin American countries (Argentina, El Salvador, Honduras, Panama, Peru, and Uruguay) from 2011 to 2013 and recently published national surveys in Paraguay were analyzed. The magnitude of absolute and relative inequalities between countries in five dimensions of eye health across the population gradient defined by three equity stratifiers (educational attainment, literacy, and wealth) were explored using standard exploratory data analysis techniques. RESULTS: Overall prevalence of blindness in people 50 years old and older varied from 0.7% (95% CI: 0.4-1.0) in Argentina to 3.0% (95% CI: 2.3-3.6) in Panama. Overall prevalence of visual impairment (severe plus moderate) varied from 8.0% (95% CI: 6.5-11.0) in Uruguay to 14.3% (95% CI: 13.9-14.7) in El Salvador. The main reported cause of blindness was unoperated cataract and most cases of visual impairment were caused by uncorrected refractive error. Three countries had cataract surgical coverage of more than 90% for blind persons, and two-thirds of cataract-operated patients had good visual acuity. CONCLUSIONS: Blindness and moderate visual impairment prevalence were concentrated among the most socially disadvantaged, and cataract surgical coverage and cataract surgery optimal outcome were concentrated among the wealthiest. There is a need for policy action to increase services coverage and quality to achieve universality.
Assuntos
Cegueira/epidemiologia , Transtornos da Visão/epidemiologia , Idoso , Idoso de 80 Anos ou mais , Benchmarking , Catarata/epidemiologia , Extração de Catarata/estatística & dados numéricos , Atenção à Saúde , Retinopatia Diabética/epidemiologia , Feminino , Política de Saúde , Inquéritos Epidemiológicos , Disparidades em Assistência à Saúde , Humanos , América Latina/epidemiologia , Masculino , Pessoa de Meia-Idade , Prevalência , Transtornos da Visão/prevenção & controleRESUMO
Objective. To conduct a comparative analysis of social inequalities in eye health and eye health care and generate baseline evidence for seven Latin American countries as a benchmarking exercise for monitoring progress toward three goals of the regional Plan of Action for the Prevention of Blindness and Visual Impairment: increasing eye health service coverage, minimizing barriers, and reducing eye health-related disease burden. Methods. Results from cross-sectional eye health surveys conducted in six Latin American countries (Argentina, El Salvador, Honduras, Panama, Peru, and Uruguay) from 2011 to 2013 and recently published national surveys in Paraguay were analyzed. The magnitude of absolute and relative inequalities between countries in five dimensions of eye health across the population gradient defined by three equity stratifiers (educational attainment, literacy, and wealth) were explored using standard exploratory data analysis techniques. Results. Overall prevalence of blindness in people 50 years old and older varied from 0.7% (95% CI: 0.4-1.0) in Argentina to 3.0% (95% CI: 2.3-3.6) in Panama. Overall prevalence of visual impairment (severe plus moderate) varied from 8.0% (95% CI: 6.5-11.0) in Uruguay to 14.3% (95% CI: 13.9-14.7) in El Salvador. The main reported cause of blindness was unoperated cataract and most cases of visual impairment were caused by uncorrected refractive error. Three countries had cataract surgical coverage of more than 90% for blind persons, and two-thirds of cataract-operated patients had good visual acuity. Conclusions. Blindness and moderate visual impairment prevalence were concentrated among the most socially disadvantaged, and cataract surgical coverage and cataract surgery optimal outcome were concentrated among the wealthiest. There is a need for policy action to increase services coverage and quality to achieve universality.
Objetivo. Realizar un análisis comparativo de las desigualdades sociales en materia de salud ocular y atención oftálmica, y generar datos probatorios de referencia de siete países latinoamericanos como un ejercicio de evaluación comparativa para vigilar el progreso hacia tres metas del Plan de Acción para la Prevención de la Ceguera y la Deficiencia Visual Evitables: el aumento de la cobertura de los servicios de salud ocular, la reducción al mínimo de las barreras y la disminución de la carga de morbilidad relacionada con la salud ocular. Métodos. Se analizaron los resultados de las encuestas transversales de salud ocular realizadas en seis países latinoamericanos (Argentina, El Salvador, Honduras, Panamá, Perú y Uruguay) desde el 2011 al 2013, y las encuestas nacionales del Paraguay recientemente publicadas. Mediante el empleo de técnicas ordinarias de análisis exploratorio de datos, se investigó la magnitud de las desigualdades absolutas y relativas entre países en cinco dimensiones de la salud ocular a través del gradiente poblacional definido por tres variables de estratificación de equidad (logro educativo, alfabetización y riqueza). Resultados. La prevalencia general de la ceguera en personas de 50 años de edad o mayores varió de 0,7% (intervalo de confianza (IC) de 95%: 0,4-1,0) en Argentina a 3,0% (IC95%: 2,3-3,6) en Panamá. La prevalencia general de la deficiencia visual (grave y moderada) varió de 8,0% (IC95%: 6,5-11,0) en Uruguay a 14,3% (IC95%: 13,9-14,7) en El Salvador. La principal causa notificada de ceguera fue la catarata no operada, mientras que la mayor parte de los casos de deficiencia visual fueron causados por un error de refracción no corregido. Tres países tenían una cobertura quirúrgica de la catarata de más de 90% para las personas ciegas, mientras que dos terceras partes de los pacientes operados de cataratas mostraban una buena agudeza visual. Conclusiones. Las prevalencias de la ceguera y la deficiencia visual moderada se concentraban en las personas más desfavorecidas socialmente, mientras que la cobertura quirúrgica de la catarata así como los resultados óptimos de esta intervención se concentraban en los más adinerados. Son necesarias acciones políticas para aumentar la cobertura y la calidad de los servicios con objeto de alcanzar la universalidad.
Assuntos
Humanos , Masculino , Adulto , Osteopecilose , Articulação do Ombro , Diagnóstico Diferencial , OsteoscleroseAssuntos
Saúde Ocular , Cegueira , Pessoas com Deficiência Visual , Prevalência , Argentina , El Salvador , Honduras , Panamá , Paraguai , Peru , Uruguai , América Latina , Saúde Ocular , Cegueira , Disparidades nos Níveis de Saúde , Pessoas com Deficiência Visual , Prevalência , Panamá , América Latina , Osteopecilose , Diagnóstico Diferencial , Osteosclerose , Desigualdades de Saúde , Articulação do OmbroRESUMO
A cross-sectional study of 373 household with 509 children aged 0-59 months was conducted in St. James to be part of a national survey and to be compared with data collected in previous years. The main objectives were to examine nutritional status in ecological areas, and compare factors related to nutritional status in 1982 and 1985 and identify areas and households at risk of malnutrition. The study underscores the need and necessity of a disaggregated database, and careful data collection procedures. The necessity for ongoing assessment is also highlighted by the study, as various factors may intervene over different periods
Assuntos
Humanos , Lactente , Pré-Escolar , Adulto , Estado Nutricional , Jamaica , Inquéritos Nutricionais , Fatores Socioeconômicos , Ingestão de Alimentos , Nutrição da CriançaRESUMO
A cross-sectional study of 373 household with 509 children aged 0-59 months was conducted in St. James to be part of a national survey and to be compared with data collected in previous years. The main objectives were to examine nutritional status in ecological areas, and compare factors related to nutritional status in 1982 and 1985 and identify areas and households at risk of malnutrition. The study underscores the need and necessity of a disaggregated database, and careful data collection procedures. The necessity for ongoing assessment is also highlighted by the study, as various factors may intervene over different periods
Assuntos
Humanos , Lactente , Pré-Escolar , Adulto , Estado Nutricional , Nutrição da Criança , Ingestão de Alimentos , Jamaica , Inquéritos Nutricionais , Fatores SocioeconômicosRESUMO
A socio-economic survey of 301 households was conducted in the parish of St. James, during 1982. Households were chosen from enumeration districts, randomly selected from within three ecologically defined strata. Urban households from wealthy districts and rural households farming over 10 acres of land were excluded. The data suggest that the prevalence of urban undernutrition has increased over the past 7-9 years. Of the observed variation in nutritional status, 28 percent was explained by 10 socio-economic variables. Of 7 categories of households identified, least at risk were those supported by professional and technical persons or farmers operating over 2.5 acres, while those most at risk were dependent on the urban unskilled and the skilled self-employed. Casual analysis revealed that although child health and food consumption were the direct precursors of child malnutrition, these were in turn due to poor household and community socio-economic conditions. The households' inability to provide adequate diets and child care appeared related to inadequate and unstable income and employment opportunities. Two public policies were evaluated. The data suggest that while the Food Assistance Plan will save some of the most at-risk from nutritional disaster, the benefits are too little to be generally effective. Better targeting and commodity choice would improve the plan. Additionally, an income supplement might be a better alternative to food stamps. The First Rural Development Project was found to have improved the incomes of beneficiaries. However, insufficient selection bias, inadvertent displacement of squatters, the number of beneficiaries and the real size of income increases make its impact small in relation to need. The study confirms the necessity to approach nutrition improvements through socio-economic development, and underscores the importance of far reaching social restructuring to prevent the continuous occurrence of malnutrition in Jamaica (AU)
Assuntos
Humanos , Lactente , Pré-Escolar , Criança , Adolescente , Adulto , Pessoa de Meia-Idade , Idoso , Masculino , Feminino , Distúrbios Nutricionais/epidemiologia , Ciências da Nutrição , Distúrbios Nutricionais/etiologia , Ingestão de Alimentos , Fatores Socioeconômicos , Comportamento Alimentar , Renda , Política Pública , Política Nutricional , Jamaica , Desemprego , Estado Nutricional , Grupos de RiscoRESUMO
A household survey was conducted in March 1982 using a stratified random sample the population in 3 ecological zones: urban (U), Rural Lowland (RL, <1000 feet), and Rural Upland (RU, >1000 feet). Households with 10 acres of land and children over 3 years were excluded. This paper examines the patterns of food consumption and assesses the adequacy of the household's consumption by use of 24-hour recall conducted by trained Community Health Aides. One hundred and three different items were reported from the 301 households in the U (N = 82), RL (N = 118), RU (N = 101) zones. Fifteen items used by at least 15 percent of the sample contributed 80.8 percent and 68.7 percent to total calories and protein respectively, in the parish, Cereals contributed 32.3 percent, 36.5 percent and 30.5 percent to total calories while root crops contributed 12.7 percent, 15.0 percent and 33.2 percent in U, RL and RU respectively. The average househeld calorie satisfaction was not significantly different for the 3 zones (106 percent), 104 percent, 110 percent) nor the proportion of households with < 80 percent calorie satisfaction. The mean protein energy per cent was 13.7 ñ 2.3 for urban, 11.7 ñ 2.8 and 10.8 ñ 2.8 for the RL and RU zones respectively (p<.001). Households spending > J$3.00/2000Kcal were 63.4 percent in urban, 55.9 percent and 56.4 percent in RL and RU zones. The average weekly food expenditure per person was J$17.2 ñ 9.1, J$13.4 ñ 7.5 and J$14.6 ñ 7.2 (p<0.5): expressed as percentage of total expenditure: 52.7 percent, 66.2 percent, and 75.3 percent, in the U, RL and RU zones (p<.01). Elasticity of demand for calories consumption was negative in the urban area (r bar to second power = 0.360; p<.001) and positive in the combined rural zones (r bar to second power = 0.502, p<.001). Certain implications are suggested byu the data: 1. Very few food items can be used to construct a food basket which could be monitored once or twice yearly. 1. The urban dwellers consumed more "luxury" items hence more expensive calories than the rural dwellers. 3. Increased income has different effects on calorie consumption depending on income class and geographical location (AU)
Assuntos
Humanos , Criança , Ingestão de Alimentos , Ingestão de Energia , Economia dos Alimentos , JamaicaRESUMO
Survey of the food consumption of a poor rural population consisting of landless households, deficit and subsistence farm households suggests that the group cannot be considered functionally homogenous as the energy intake differed according to income and food distribution. The nutritional status of pre-school age children in landless households was less than that of the others. Concludes that the undernutrtion in these areas was partly due to inadequacy of household food resources. Suggests that development efforts to relieve poverty in this area should address the need for employment opportunities among the functionally landless, supplements to current farm lands or wage work opportunities for some households and extensive services to help farmers to increase their productivity and income. (AU)