Accessibility And Affordability Of Tertiary Education In Brazil, Colombia, Mexico And Peru Within A Global Context

So far, there have been no bibliometric or scientometric studies that make it possible to examine, with quantitative, retrospective, and comprehensive criteria, the scientific output on public health in Latin America and the Caribbean (LAC). Further, the weakness of the existing information systems makes it impossible to examine the relevance, quality, and impact of this scientific output, with a view to evaluating it in terms of societal needs and existing patterns of scientific communication. This article presents the results of a bibliographic analysis of the scientific output in the area of public health in Latin America and the Caribbean. The ultimate goal of the analysis is to build a model of scientific communication in this field, to help researchers, managers, and others working in the area of public health to make decisions and choose actions to take. We conducted a literature review in order to identify the distribution of publications on public health that were produced by LAC researchers and published in each of the LAC countries from 1980 through 2002. The review used the Literatura Latino-Americana e do Caribe em Saúde Pública (LILACS-SP) (Latin American and Caribbean Literature on Public Health) bibliographic database. That database is operated by the Latin American and Caribbean Center on Health Sciences Information (BIREME), which is in São Paulo, Brazil. We processed the LILACS-SP data using two software packages, Microsoft Excel and Bibexcel, to obtain indicators of the scientific output, the type of document, the language, the number of authors for each publication, the thematic content, and the participating institutions. For the 1980-2002 period, there were 97,605 publications registered, from a total of 37 LAC countries. For the analysis presented in this article, we limited the sample to the 8 countries in Latin America and the Caribbean that had at least 3,000 documents each registered in the LILACS-SP database over the 1980-2002 study period. In descending order of the number of publications registered, the 8 nations were: Argentina, Brazil, Chile, Colombia, Cuba, Mexico, Peru, and Venezuela. Those 8 countries were responsible for 83,054 publications (85.10% of the total of 97,605 registered documents produced by the 37 LAC countries). Of those 83,054 publications from the 8 countries, 56,253 of them (67.73%) were articles published in scientific journals and 24,488 were monographs (29.48%). The proportion of works produced by two or more coauthors was relatively high (56.48%). The 56,253 articles appeared in a total of 929 different journals. Of the 929 journals, 91 of them published at least 150 articles over the study period. In descending order, LAC journals with the largest number of articles on public health were: Revista de Saúde Pública (Brazil); Cadernos de Saúde Pública (Brazil); Revista Médica de Chile; Archivos Latinoamericanos de Nutrición (Venezuela); and Salud Pública de México. The 91 journals that published at least 150 articles represented 29 different specialties. The most common of the specialties for the 91 journals were general medicine (18 journals) and pediatrics (10 journals). In descending order, the populations that the publications dealt with primarily were human beings in general, females, males, and adults; and, in descending order, a relatively small number of publications dealt with pregnant women and middle-aged or elderly persons. The topics most often covered in the publications were risk factors, health policy, and primary health care, as well as family doctors in the case of Cuba. This research produced a preliminary model of communications in public health in LAC countries that will hopefully help lay the groundwork for further research to develop a model of scientific communication in LAC nations.

ABSTRACTObjectives.Three highly effective vaccines are available to prevent human papillomavirus (HPV) infection, and they have been introduced in many countries around the world. This article describes advances and challenges in introducing HPV vaccines in the Expanded Program of Immunization (EPI) of countries in Latin America and the Caribbean (LAC).Methods.We reviewed national and regional sources of information to identify LAC countries with and without universal HPV vaccination, along with the year of introduction, type of HPV vaccine, vaccination scheme, age groups targeted, and coverage level reached. Incidence rates of cervical cancer were compared across countries with and without an HPV vaccination program, in order to identify inequities in access to HPV vaccines.Results.So far, 10 LAC countries have supplied data on their vaccination policies and vaccination coverage rates to the Pan America Health Organization. The majority of those 10 started their vaccination programs using quadrivalent vaccine. Only Chile, Ecuador, and Mexico started their programs using a two-dose scheme. However, by the end of 2016, most of the other countries had switched from a three-dose to a two-dose scheme. Different age groups are targeted in the various programs. Some countries vaccinate one-year birth cohorts, while others vaccinate multiple-year birth cohorts. By the end of 2014, coverage with at least two doses ranged from a low of 2% to a high of 86%. With the exception of Venezuela, the LAC countries with the largest populations introduced universal HPV vaccination between 2010 and 2014. Despite the progress that has occurred in some LAC countries, there are still 10 LAC nations with cervical cancer rates above the LAC average (21.2 cases per 100 000) that have not introduced an HPV vaccine in their EPI.Conclusions.With several key adjustments, HPV vaccination programs across Latin America and the Caribbean could be substantially strengthened. Ongoing monitoring of HPV infection outcomes is needed in order to assess the impact of different vaccination policies.

BackgroundThe recent Zika virus (ZIKAV) epidemics disclosed a major public health threat and a scientific and technological (S&T) challenge. The lessons learned from the S&T response of Latin America and the Caribbean (LAC) countries are critical to inform further research and guide scientific investments. The present study aimed to assess how new S&T knowledge produced and disseminated regionally can contribute to address global health challenges.MethodsScientometric and social network analysis methods were used to assess the LAC scientific contribution and potential technological development on ZIKAV up to December 2017. ZIKAV-related publications were retrieved from the Web of Science, Scopus, and PubMed databases. Regionally published articles were obtained from SciELO (Scientific Electronic Library Online) and LILACS (Literature in the Health Sciences in Latin America and the Caribbean) databases. Patent registries were retrieved using Orbit Intelligence and Derwent Innovation. Records from each database were individually downloaded, integrated, standardized and analyzed.ResultsWe retrieved 5421 ZIKAV-related publications, revealing a sharp increase from 2015 onwards. LAC countries accounted for 20% of all publications and Brazil was among the top three most central countries in the global network for ZIKAV research. A total of 274 patent families backed up by experimental evidence were retrieved. Only 5% were filed by LAC assignees, all of them based in Brazil. The largest contribution of LAC research was on the clinical manifestations of the ZIKAV infection, along with vector control, which was also the main focus of patents.ConclusionsOur analysis offered a comprehensive overview of ZIKAV’s research and development and showed that (i) LAC countries had a key role in generating and disseminating scientific knowledge on ZIKAV; (ii) LAC countries have expressively contributed to research on ZIKAV clinical manifestations; (iii) the Brazilian scientific community was potentially very effective in knowledge sharing and diffusion in the ZIKAV research network; (iv) Brazil was the single LAC country filing patents, mostly represented by independent inventors and low-tech patents. The paper advocates the need for a continued interdisciplinary approach to improve LAC countries ability to prevent, prepare for and control future outbreaks.

Background:Stroke is the second largest single cause of death and disability in Latin America and the Caribbean (LAC). There have been large overall declines in stroke mortality rates in most LAC countries in recent decades.Objective:To analyze trends in mortality caused by stroke in LAC countries in the period 1979–2015.Methods:We extracted data for age-standardized stroke mortality rates per 100,000 in LAC for the period 1979–2015 from the World Health Organization Mortality Database. Joinpoint regression was used to analyze the trends and compute the annual percent change (APC) in LAC as a whole and by country. Analyses were conducted by gender, region and World Bank income classification.Results:Mortality from stroke has decreased in LAC over the study period by an average APC of –1.9%. Most countries showed significant downward trends, with the sharpest decreases in Chile, Colombia and Uruguay. We recorded statistically significant decreases of –1.4% and –2.4% in mortality rates in men and women, respectively, in the whole LAC. Southern and high-income countries showed the steepest decreases.Conclusions:Stroke mortality has decreased in LAC, in both sexes, especially in southern and high-income countries. Our results could serve as a reference for the development of primary prevention and acute management of stroke policies focused on countries with higher mortality.

BackgroundThe prevalence of dementia in Low and Middle‐Income Countries (LMICs), particularly in Latin America and the Caribbean (LAC), is projected to triple by 2050. The Montreal Cognitive Assessment (MoCA) is widely used for cognitive evaluation, but its uniform application in LAC is questionable, especially due to cultural and linguistic diversity of the Spanish‐speaking LAC countries.MethodA systematic literature search was conducted across seven databases, supplemented by a comprehensive review using Google Scholar to identify relevant grey literature. Studies validating or culturally adapting the MoCA, conducted in Spanish‐speaking institutions in the LAC region, with available psychometric measures and comparisons to gold‐standard diagnostic criteria, were considered for inclusion. Fourteen studies were identified that validated the MoCA in LAC. Twelve studies meeting inclusion criteria were analyzed using the Manchester Cultural Adaptation Questionnaire and Manchester Translation Reporting Questionnaire. The adaptation process and psychometric reports were thoroughly assessed.ResultAmong all reviewed articles, 12 detailed MoCA validation across LAC populations (Fig. 1). Only two reported significant adaptations to the original version, with one study providing a detailed cultural rationale (Table 1). The adaptation process assessment revealed limited reporting on translation steps (Table 2). Concerning the psychometric report, internal consistency, criterion validity, and construct validity were the most frequently addressed aspects across all studies. In all studies where low‐educated populations were evaluated, educational level was reported to bias the results. We identified a lack of standardized criteria for definition of illiteracy across the studies.ConclusionThis systematic review identified limited reporting on translation steps emphasizes the need for standardized processes in future adaptations. We recommend cultural awareness during MoCA administration in the region. Future studies must address appropriate cut‐off scores based on educational level adjustments in LAC countries.

The Every Woman Every Child Latin America and the Caribbean (EWEC-LAC) initiative was established in 2017 as a regional inter-agency mechanism. EWEC-LAC coordinates the regional implementation of the Global Strategy for Women’s, Children’s and Adolescents’ Health in Latin America and the Caribbean (LAC), including adaptation to region specific needs, to end preventable deaths, ensure health and well-being and expand enabling environments for the health and well-being of women, children and adolescents. To advance the equitable achievement of these objectives, EWEC-LAC’s three working groups collectively support LAC countries in measuring and monitoring social inequalities in health, advocating for their reduction, and designing and implementing equity-oriented strategies, policies and interventions. This support for data-driven advocacy, capacity building, and policy and program solutions toward closing current gaps ensures that no one is left behind. Members of EWEC-LAC include PAHO, UNAIDS, UNFPA, UNICEF, UN WOMEN, the World Bank, the Inter-American Development Bank, USAID, LAC Regional Neonatal Alliance, and the LAC Regional Task Force for the Reduction of Maternal Mortality. To date, EWEC-LAC has developed and collected innovative tools and resources and begun to engage with countries to utilize them to reduce equity gaps. These resources include a framework for the measurement of social inequalities in health, data use and advocacy tools including a data dashboard to visualize trends in social inequalities in health in LAC countries, a methodology for setting targets for the reduction of inequalities, and a compendium of tools, instruments and methods to identify and address social inequalities in health. EWEC-LAC has also engaged regionally to emphasize the importance of recognizing these inequalities at social and political levels, and advocated for the reduction of these gaps. Attention to closing health equity gaps is ever more critical in the face of the COVID-19 pandemic which has exploited existing vulnerabilities. More equitable health systems will be better prepared to confront future health shocks.

The countries of Latin America and the Caribbean (LAC) have made significant economic and social progress in the past two decades but, with the recent slowdown in the global economy, the region’s growth rate began to decline. That circumstance has been compounded by the grave health crisis caused by the Covid-19 pandemic, which has had an extraordinary impact on the region's economies and reminds us how vulnerable the LAC countries are to external shocks. If LAC makes the right policy decisions, however, the countries of the region could resume the path of economic growth and continue their progress towards becoming developed nations. Investment in infrastructure could be the key to bringing about this transformation. Closing the infrastructure gap that separates the region from developed countries is a precondition for making LAC a high-income region. The main obstacle to achieving this high level of public investment is the LAC countries’ limited fiscal capacity: hence the need to expand fiscal space. There is also a need to raise productivity, and to boost private and public investment in innovation, in the use of new technologies, and in building proficiencies and skills. All of this must be complemented by public policies that foster competitiveness as well as flexible and open markets, in a framework of respect for property rights. Finally, the extraordinary growth of the middle class in LAC, as well as the decline in poverty levels, poses new challenges for the development of these countries and for public policymaking. Adopting and maintaining a policy of sustained growth with equity is the best response to the new set of demands arising from the recent upward social mobility of broad sectors of the population in Latin America. Social policy should emphasize insurance mechanisms for this new middle class, in terms of pensions and employment. In the coming decades, massive investment will also be needed in education, health care, and improving the quality of public services. This monograph is one of a series on the Andean countries. The other, individual books on each country offer analyses and proposals for specific policies to accelerate growth and strengthen the middle class in Bolivia, Colombia, Ecuador, and Peru.

Studies have shown that the prevalence of dementia in Latin America and the Caribbean (LAC) may be higher than in high-income countries. Thus, we sought to systematically analyse the prevalence of dementia and explore possible drivers that lead to this disparity in LAC countries. We searched Pubmed, Web of Knowledge, Scopus, Lilacs, and SciELO for studies on dementia in LAC countries published in English, Spanish, and Portuguese. Random-effects model was applied. Thirty-one studies from 17 LAC countries were included. Pooled prevalence of all-cause dementia was 10.66%. Further analyses with studies providing raw prevalence by sex, area, and educational level showed a higher prevalence for women (8.97%) than for men (7.26%). Also, dementia prevalence was higher for rural than urban residents (7.71% vs 8.68%, respectively). Participants without formal education presented more than double the prevalence of dementia (21.37%) compared to those with at least one year of formal education (9.88%). Studies with more recent data collection showed higher dementia prevalence. Our findings suggest a high global dementia prevalence in LAC countries and an unequal burden of dementia for women, lower-educated, and rural residents. Secular increases in dementia prevalence call for greater public health efforts for preventative actions.

Background. The population of Latin America and the Caribbean (LAC) is ageing rapidly, presenting the highest prevalence rates of dementia in the world. In this context, mild cognitive impairment (MCI) is an intermediate condition between normal ageing and dementia. However, very few studies verified the prevalence of MCI in LAC countries; earlier global systematic reviews only considered prevalence reports published in English language. Method. We conducted a systematic review to evaluate the prevalence of MCI in LAC countries and to explore the factors associated with MCI (i.e., age, gender, and education). A database search was conducted in February 2020 using PubMed, Web of Science, Scopus, Lilacs, SciELO, and EMBASE, for population-or community-based studies with MCI data for countries in LAC, published in English, Spanish, or Portuguese language. From k=2,168 identified and k=1,684 screened studies, only articles were selected that included subjects with a precise diagnosis of MCI. The studies were qualitatively assessed using the JBI critical appraisal checklist for studies reporting prevalence data tool. Results. A total of nine studies met the criteria, published between 2007 and 2019, including a total of 17,812 participants in nine countries Brazil, Mexico, Argentina, Colombia, Peru, Cuba, Dominican Republic, Venezuela, and Costa Rica. Estimates for MCI prevalence ranged from 1.2% to 34%, with most estimates between 1.2% and 6.45%. Estimates differed by age group, gender, and educational level. Discussion. This is the first systematic review of the prevalence of MCI in LAC countries, considering only high-quality studies adopting rigorous diagnostic criteria.

Managed aquifer recharge (MAR) is being used worldwide as a tool to overcome distinct water management challenges. An analysis of MAR case studies from different countries in Latin America and the Caribbean (LAC) was carried out as part of a larger study focused on the compilation of a global inventory of MAR schemes which aims at providing guidance for the planning and implementation of new MAR projects. The MAR case studies were collected from freely available scientific publications. These were classified according to the specific MAR type developed, main objective and the source of the influent water. Most reported cases (>60%) were found in Brazil, followed by Mexico and Chile. The main MAR type reported in LAC is in-channel modification, which represents more than half of the reported MAR schemes, and the main influent water used is river water and storm water (together accounting for >90% of cases). Approximately two-thirds of the MAR cases in LAC were developed to maximize natural storage. Publication of freely available scientific reports on MAR in LAC is scarce; however, this is not due to lack of MAR projects, but rather suggests insufficient motivation in sharing experiences with the international scientific community. Nevertheless, MAR has been successfully implemented in at least ten LAC countries. For four of these, estimates of annual recharge volume are available—Mexico (156 Mm3), Cuba (115 Mm3), Peru (36 Mm3) and Costa Rica (4 Mm3)—and a further 30 Mm3 are crudely but conservatively calculated for the remaining LAC countries (mostly in Brazil) bringing the total to approximately 340 Mm3. The application of MAR is expected to grow further as a sustainable and reliable tool to address challenges related to climate, population and economic changes.

Latin America and the Caribbean (LAC) is a rapidly growing region with almost 600 million inhabitants composed of Mexico, Central and South America, and the islands of the Caribbean. The...

Socioeconomic Impact of Cancer in Latin America and The Caribbean

The key finding of this report is that the euro is not likely to cause any single major change in Latin America and the Caribbean (LAC). There will, however, be a lot of small effects--in different directions--in the short and long run. In the main, the impact of the euro on Latin America is expected to be of secondary importance, since no structural trade change is expected. Because the LAC countries are very heterogeneous, the European and Economic and Monetary Union (EMU) and the euro are therefore likely to impact countries differently. Countries and regions with strong links--culturally and geographically--to the United States (such as Mexico and Central America) are likely to be less affected than countries with weaker links. The report's main findings are the following: 1) The European Union should increase imports from the LAC region. 2) Because LAC countries are highly dollarized, a major immediate change is not expected with the euro's launching, rather the main impact is likely to come through financial linkages. 3) Increased financial deepening in Europe could lead to a small increase in exports for LAC. 4) The immediate impact on debt value and debt service is expected to be small. 5) LAC countries may become more attractive as destinations for European investors seeking diversified portfolios. 6) LAC and Mercosur cannot be seen as optimal currency areas at this time.

After a two-year recession, something last experienced over three decades ago, the Latin America and the Caribbean (LAC) region is growing again. The challenge now is to accelerate and sustain growth to continue making progress on the social front as in the first decade and a half of the new century: between 2000 and 2014 the region managed to reduce poverty (US$4 a day poverty line) from 42.9 percent to 23.3 percent, cutting the number of poor people by 80 million at a time when the Latin American population increased by 100 million. A renewed emphasis on productivity comes up during any discussion of LAC’s growth agenda. After all, labor productivity in the region has stalled at around 30 percent of that of the U.S. Moreover, improvements on the productivity front would result not only in faster growth but also, as basic economic theory suggests, in better salaries for the workforce, therefore further contributing to poverty reduction and shared prosperity. But why is there such a gap in LAC’s productivity with respect to the developed countries? One factor is the large infrastructure investment and service gaps. Infrastructure investments can be a powerful engine for reviving and sustaining growth. A recent regional study on the determinants of growth in LAC indicates that infrastructure has been the main structural driver of growth in the region. Yet, LAC governments are well aware that public resources are not enough to satisfy infrastructure needs, especially in the context of ongoing fiscal adjustments across the region and the enormous need for infrastructure investment: an estimated $180 billion per year investment gap. And LAC governments are also aware that the private sector can play a central role to finance the existing gap. Not surprisingly then, LAC has made considerable strides in attracting private sector investments in infrastructure: the region has the largest stock of active Public-Private Partnerships (PPP) investments and the largest pipeline of infrastructure projects by volume globally, reflecting the central role of the private sector in the regional development agenda. Going forward, LAC countries will benefit from an improved environment for private investments, as well as for further developing a robust pipeline of bankable projects. This report showcases the different ways the World Bank Group has been part of these efforts to support the mobilization of private financing for infrastructure in the region, following what authors call the Cascade approach. These encompass everything from policy and regulatory advice to structuring support, guarantees schemes and financing. Country-specific examples presented in this report illustrate how private financing mobilization in LAC has been supported by the WBG. While not exhaustive, these examples are representative of the different strategies and instruments used by governments at the central and subnational levels to help leverage private sector participation in infrastructure. The WBG stands ready to continue to assist the region in that endeavor with financial support, as well as knowledge and convening services.

The area of land viable for agriculture is diminishing each year due to topsoil erosion, loss of soil fertility, water insecurity and climatic change, factors which limit productivity and threaten crop yields. The changing climate will exaggerate the existing differences between developed and developing countries and may also see pests and diseases infiltrating wider geographical zones, further threatening productivity. These factors are particularly important for many countries in Latin America and the Caribbean (LAC). Hence, with the current range of agricultural land having reached a supply threshold and limited prospects of increasing the area, the rate of increase in food production will not keep pace with the rate of population growth. Modern biotechnology offers a means of delivering sustainable agricultural practices and this chapter provides an overview of the institutions and research projects in LAC countries, whose objective is to provide more food in a safe, sustainable way. There is a wealth of research being undertaken in Latin America on both commodity crops and locally‐important staples. Molecular breeding, genetic engineering, in vitro micropropagation, germplasm screening and conservation projects are being used to identify useful traits, improve resistance to a variety of abiotic and biotic factors and boost crop yields throughout the region. An overview of the current status of GM crops–research, approval and commercialisation status–demonstrates that these biotechnological methods, together with the development of novel bioproducts and integrated pest management strategies, are facilitating an environmentally conscious attitude to crop protection and enabling more sustainable agricultural practices in a number of countries from the LAC region. Engineering crops that are tailored to the environment, so as to resist climate change and environmental stress, may permit marginal lands to be brought into agricultural use to produce locally‐important crops and commercially relevant crops for a growing population, as well as feed for the livestock on which the population depends. Some countries in Latin America, such as Costa Rica and Colombia, have a particularly rich biodiversity so changing agricultural practices and the adoption of genetically modified (GM) varieties in such regions must not pose a threat to local biodiversity. Projects to assess the likelihood of GM traits passing into weedy and wild relatives are being conducted in centres of biodiversity for key crops within Latin America. Agriculture in Latin America will come under increasing pressure to provide food, income and livelihoods for current and future generations. Its success will depend on the appropriate integration of traditional methods with contemporary technologies to enhance productivity in a sustainable way, without jeopardising ecological security.