Health In Central America Research Articles

P-736 Twins, an instant family: beyond the risks and health in Central America

Abstract Study question Why do patients attending fertility centers in Centralamerica consider twins as the best possible outcome? Summary answer In Centralamerica patients expect to have twins after a fertility treatment. Preliminary results show that, from a specialist’s perspective, this expectation might be financially driven. What is known already Twins have fascinated humanity since early times. Every culture in the world has a different reaction to the birth of twins and has myths about them. Some myths are still present in current times and affect our decisions. After a fertility treatment, the likelihood of having twins increases, which has contributed to a worldwide increase of the twin birth rate. In spite of the risks, some patients prefer to have twins. Study design, size, duration This is a qualitative study based on anthropological theory and ethnographic research. Semi-structured interviews were conducted to infertility specialists during July of 2020 in Centralamerica. These six countries are a cultural region that shares historical and economic features which enables a socio-cultural anthropological research. The framework for the interview’s structure is the ecological paradigm from medical anthropology theory. In this paradigm the individual is seen as part of a context that influences their medical decisions. Participants/materials, setting, methods The participants were infertility specialist who had more than 3 years of experience and practice reproductive medicine in Central America. The method was a semi-structured interview via Zoom and was recorded and then transcribed with the software Transcriptions Version 1.2. The results were coded and analyzed with cognitive anthropology methods to identify cultural models in the speech. In ethical aspects, the confidentiality of the interviewee was considered important and was protected through informed consent. Main results and the role of chance The results of the interviews with infertility specialists indicate that they have difficulties explaining patients about the risks and complications of a multiple pregnancy. According to the physicians, many patients expect twins after a treatment. The patients have the idea that they will have “two for one” (“dos de un solo”) and believe that the raising of two babies will require less time and money. The birth of twins is considered a “double blessing” (“doble bendicion”) or a “double price” (“doble premio”). With one single treatment they hope to get the “ideal family” that consist of one girl and one boy (“tener la parejita”). The patients have preconceived ideas that are influenced by their environment, like family members, friends and the media. Central America was part of the mesoamerican region were maya and aztecs myths continue to influence the popular culture and people continued to believe that twins have special connections and could have a good sibling relationship. Physicians are not aware that the media and family have so much weight in the medical decisions of their patients only focus on the fact that patients underestimate the risks. Limitations, reasons for caution The reason for caution is that this is a local study that cannot be generalized in time and place. Wider implications of the findings The results would help to design interviews for patients with the final purpose of understanding their perceptions and attitudes toward twins. In a region with no public health policies regarding infertility treatments, the results can improve communication between the doctors and patients to reduce twin rates. Trial registration number (')

Exploring social innovation in health in Central America and the Caribbean.

ABSTRACTUniversal health coverage is a public health priority in the Americas. Social innovation in health offers novel solutions to unmet needs, by enabling health care delivery to be more inclusive, affordable, and effective. In 2017, an international collaborative consortium launched an open call for solutions that sought to identify social innovations in health in Central America and the Caribbean. The focus was set on how these solutions can strengthen health care delivery, with emphasis on reducing the impact of neglected transmissible diseases. A crowdsourcing strategy was implemented to identify social innovations in health. These were evaluated by an external panel of experts and practitioners and civil society representing the health and social innovation sectors, based on the appropriateness, innovativeness, and affordability of the solution. The three top-scoring solutions were analyzed through case studies including site visits by a team of investigators. Two key findings emerged from the response to the call: 1) innovative solutions were based on the knowledge and experience of individuals and communities facing adverse situations; 2) this knowledge was shared through health promotion and education, leading to empowerment of the communities. The principal challenges addressed by the solutions were the limited access to quality health care services and failed traditional strategies for vector control. The solutions identified demonstrated how social innovation can strengthen health systems by delivering novel solutions to health needs and articulating communities to enable them to work hand-in-hand with the health system toward universal health.

Extra-ordinary aid and its shadows: The work of gratitude in Nicaraguan humanitarian healthcare

Nicaragua has the lowest per capita spending on health in Central America. Public clinics lack medications for chronic disease management; many citizens obtain prescriptions but cannot afford to get these filled; poorly equipped and under-staffed operating theatres function part-time while waiting lists swell. This is the context within which dozens of international healthcare missions travel to Nicaragua every year to provide surgical and primary care to the country’s poor. This article is based on research conducted in 2013 on Nicaraguan encounters with and moral framings of foreign surgical and primary care missions working in their communities. It draws on critical humanitarian studies and queer affect theory in attending to and analyzing references to gratitude within these accounts, asking what local and trans-national relations Nicaraguan narratives of gratitude toward medical aid help form, limit, and enable.

Gender-Specific Jealousy and Infidelity Norms as Sources of Sexual Health Risk and Violence Among Young Coupled Nicaraguans.

Gender inequity negatively affects health in Central America. In 2011, we conducted 60 semistructured interviews and 12 photovoice focus groups with young coupled men and women in León, Nicaragua, to explore the ways in which social norms around marriage and gender affect sexual health and gender-based violence. Participants' depictions of their experiences revealed gendered norms around infidelity that provided a narrative to justify male expressions of jealousy, which included limiting partner autonomy, sexual coercion, and physical violence against women, and resulted in increased women's risk of sexually transmitted infections, including HIV. By understanding and taking account of these different narratives and normalized beliefs in developing health- and gender-based violence interventions, such programs might be more effective in promoting gender-equitable attitudes and behaviors among young men and women in Nicaragua.

Unaccompanied Immigrant Minors: Where to Begin

The number of unaccompanied immigrant minors (UIMs) from Central America significantly increased in 2014. Nearly 50,000 children from El Salvador, Guatemala, and Honduras crossed the United States–Mexico border in 2014, compared with 3,933 in 2011. Few resources exist to guide pediatric nurse practitioners (PNPs) in their care of UIM. The multifactorial reasons behind migration and the state of children's health in Central America provide insight into the needs of UIMs. Guidelines for similar groups such as foreign-born children and refugees offer direction for the health care considerations of UIMs. This article provides demographic information on UIMs, highlights the unique and challenging medical and mental health issues facing UIMs, and discusses the role of the PNP. A UIM's initial visit with a PNP serves as an opportunity to build trust through culturally competent, trauma-informed care, provide preventive care, assess for unmet health needs, and screen for mental health conditions.

Child health in Central America and the Caribbean

Central America consists of seven mainland countries: Belize, Costa Rica, El Salvador, Guatemala, Honduras, Nicaragua and Panama. The Caribbean Sea contains over a thousand islands. Many of the islands are...

Working conditions and health in Central America: a survey of 12 024 workers in six countries

ObjectiveTo describe the survey methodology and initial general findings of the first Central American Survey of Working Conditions and Health.MethodsA representative sample of 12 024 workers was interviewed at home...

35 Working conditions and health in Central America

ObjectiveTo describe the initial results of the first Central American Survey of Working Conditions and Health, completed in 2011.MethodsA cross-sectional survey of a representative national sample of 12,024 workers (2004...

Women’s Health in Central America: The Complexity of Issues and the Need to Focus on Indigenous Healthcare

The Central American (CA) isthmus consists of seven countries including Belize, Costa Rica, El Salvador, Guatemala, Honduras, Nicaragua and Panama, some of the poorest countries in the world. Over the past twenty years, CA has made good progress in improving the health status of their populations. Analysis of the peer-reviewed literature, as well as national and international reports show that life expectancy at birth has increased and child mortality rates have fallen. Maternal mortality ratios (MMR) have declined by approximately 33%, however the MMRs for indigenous women remain at unacceptable levels. Despite the advances, made in many CA countries, the overall health status remains well below Latin American averages. In fact, in most CA countries, poor health outcomes are increasingly concentrated geographically among the poor and indigenous populations. Considering indigenous people make up the second largest population group in CA, any improvements in healthcare should significantly improve the health statistics for these countries. For these populations, the integration of local cultural practices and traditional healing methods with modern medicine and healthcare facilities is critical for acceptance. Investigations and analyses of local cultures, knowledge and traditional medicine practices should be used to determine the factors that contribute to poor health in these populations. Local health educational programs are needed, especially those that would involve men (spouses), families and entire communities. Furthermore, manywomen's reproductive issues still need to be addressed, particularly those that focus specifically on maternal mortality and cancer. For reductions in maternal mortality, El Salvador and Costa Rica may be good examples to follow. Access to inexpensive (or free) healthcare that is culturally sensitive and community based, particularly for indigenous women, would greatly improve the overall health. The major stumbling blocks to progress are that the funding for programs to reduce maternal mortality is woefully inadequate and that there has not been a focus on improving healthcare for indigenous women.

Evaluating the bio-hydrological impact of a cloud forest in Central America using a semi-distributed water balance model

Abstract Water scarcity poses a major threat to food security and human health in Central America and is increasingly recognized as a pressing regional issues caused primarily by deforestation and population pressure. Tools that can reliably simulate the major components of the water balance with the limited data available and needed to drive management decision and protect water supplies in this region. Four adjacent forested headwater catchments in La Tigra National Park, Honduras, ranging in size from 70 to 635 ha were instrumented and discharge measured over a one year period. A semi-distributed water balance model was developed to characterize the bio-hydrology of the four catchments, one of which is primarily cloud forest cover. The water balance model simulated daily stream discharges well, with Nash Sutcliffe model efficiency (E) values ranging from 0.67 to 0.90. Analysis of calibrated model parameters showed that despite all watersheds having similar geologic substrata, the bio-hydrological response the cloud forest indicated less plantavailable water in the root zone and greater groundwater recharge than the non cloud forest cover catchments. This resulted in watershed discharge on a per area basis four times greater from the cloud forest than the other watersheds despite only relatively minor differences in annual rainfall. These results highlight the importance of biological factors (cloud forests in this case) for sustained provision of clean, potable water, and the need to protect the cloud forest areas from destruction, particularly in the populated areas of Central America.

Social Determinants of Workers' Health in Central America

This communication summarizes the available data on work-related determinants of health in Central America. The Central American working population is young and moving from agriculture toward industry and services. Ethnicity, gender, migration, subemployment and precarious work, informality, rural conditions, low-level educational, poverty, ubiquitous worksite health hazards, insufficient occupational health services, low labor inspection density, and weak unions define the constellation of social determinants of workers' health in Central America. Data are, however, scanty both for hazards and work-related illnesses and injuries. Governments and industries have the responsibility of opening decent work opportunities, especially for those facing multiple inequalities in social determinants of health. A first step would be the ratification and implementation of the ILO Convention (187) on occupational safety and health by the seven national governments of the region.

Social Determinants of Workers' Health in Central America

Social Determinants of Workers' Health in Central America

SALTRA: A Regional Program for Workers' Health and Sustainable Development in Central America

In 2003, the university-based Program on Work and Health in Central America, SALTRA, was launched to build national and regional capacities in occupational safety and health with the goal of preventing and reducing poverty in Central America. SALTRA has implemented 20 projects including action projects in priority sectors (e.g., construction, sugarcane, hospitals, migrant coffee workers); strengthening of surveillance (occupational health profiles, carcinogenic exposures, fatal injuries and pesticides); a participatory model for training and risk monitoring by workers; building occupational health capacity for professionals, employers, and workers, with collaborating networks between the countries; strengthening of universities in work, environment, and health; studies of serious occupational and environmental situations; communication channels; and continued efforts to raise political awareness. SALTRA has placed issues of workers' health on political, business, and academic agendas throughout the region and has laid the foundations for achieving substantial future improvements in health conditions of all workers in the region. External evaluators envisioned SALTRA as an innovative development model.

Health and philanthropy—the tobacco connection

On June 14, the world's two richest men, Mexico's Carlos Slim Helú and the USA's Bill Gates, jointly announced that they would each contribute US$50 million to the Latam health project to increase vaccinations and improve child nutrition and natal health in central America.1 Slim already contributes reputedly $2·5 billion annually to his Instituto Carlos Slim de la Salud, which runs a large variety of health programmes in Latin America.2 The latest announcement will naturally attract widespread acclaim as an outstanding example of philanthropy.

Salud y ambiente en Centroamérica según modelo de factores de estrés

Luego de dar cuenta del contexto geográfico, social y económico al que pertenece el asentamiento Louisiana (en Se da cuenta de la aplicación del modelo exposición-enfermedad-estrés (planteado por Gee y Payne-Sturger [2004]) a nivel de regiones geográficas centroamericanas para explicar por qué la salud es diferente en las distintas regiones. Se demuestra la correlación entre ciertos factores (relacionados con recursos del vecindario, con estresores comunitarios, con factores estructurales y con peligros ambientales) y las diferencias en salud en Centroamérica. Se determinó seis factores que explican el 85 por ciento de la variabilidad.

Registration of Occupational Diseases in Costa Rica

ISEE-296 Objective: Previous efforts have been developed in Costa Rica to systematize and unify the registration of occupational diseases, but with nonpositive results. To better assess the feasibility to standardize the report of occupational risks, the Program in Work and Health in Central America (SALTRA) is conducting a project in 2 CA countries. We are presenting the advances in Costa Rica. Material and Methods: Diagnosis of current situation was performed through revision of various sources: legal situation, existing databases on health institutions, communication with key persons involved in the process of disease classification and registration, existing documents as previous evaluations and proposals, and theses. An interinstitutional group was developed by representatives from Ministries of Labor (MT) and Health (MS), Social Security System (CCSS), National Insurance Company (INS), Occupational Health and Safety Committee (CSO), and the Society of Occupational Medicine (ACOMET), led by an academic institution, Universidad Nacional (UNA). Results: We present preliminary results of the project. An integration of databases from 2 institutions (INS MS) is under development. A project for the inclusion of diagnosis of occupational diseases as legally mandatory for declaration has been proposed. A proposal for a pilot study on surveillance system in one geographic region of the country, for a limited number of diseases and a training program of first care physicians, has been proposed. Conclusions: Our experience shows an interesting collaboration effort from different institutions and the important role of the academic sector in the integration of sources and communication between sectors of the population.

Esbozo histórico de la medicina estatal en América Central

This essay sketches the fundamental characteristics of state medicine and public health in Central America, with an emphasis on the 20th century. The picture is variable, given the distinct configurations of political regime, ethnic division, and social conflict, some of them quite extreme. A high degree of historical continuity is noted in the way these factors have influenced the formation or deformation of public health and state medicine systems. Although external agents have had a strong presence in the health sector of most Central American countries, the paper argues that the historical forces that determine the nature of state medical systems in the isthmus are internal rather than external. Despite the historically weak development of state medicine in most countries, the question of public access to medicine has played an important and often highly charged role in the political life of most Central American countries.

Public health in Central America.

IN LATIN AMERICA, THERE HAS long been a running debate over the relative effectiveness of “vertical” rather than “horizontal” programs in public health. In the 1950s, when this photograph was taken, the Pan American Sanitary Bureau (forerunner of the Pan American Health Organization, or PAHO) was engaged in vertical malaria, yaws, and smallpox eradication campaigns under the direction of Fred L. Soper, a former Rockefeller Foundation officer, who directed the Bureau from 1947 to 1959.1 This image from the Soper archives provides evidence that, despite the predominant emphasis on technical interventions that characterized the disease eradication campaigns, there was also another approach to public health. Here, a visiting nurse from the Institute of Nutrition in Magdalena, Guatemala, is examining a child suffering from a scalp infection. In the 1950s, visiting nurses working in shantytowns and rural areas were a new development in Central American public health. The institute organized some of the first community-based health programs that would later become a central aspect of horizontal primary health care programs in the 1970s and 1980s. The Pan American Sanitary Bureau and the ministers of health of Costa Rica, El Salvador, Guatemala, Honduras, Nicaragua, and Panama first decided to create the Institute of Nutrition in 1946 and then formally inaugurated it in September 1949. The institute conducted pioneering clinical and epidemiological studies and interventions aimed at identifying and correcting dietary deficiencies in Central America, and it developed some of the first studies on the chemical composition of foods used by the population. Early on, the institute viewed undernutrition as a major health problem—closely associated with poverty—that was responsible for retarding the growth of children and making them vulnerable to infectious diseases. The institute emphasized the value of vitamin supplements in correcting some of these problems. Today, the institute is known as the Instituto de Nutrition de Centro America y Panama (INCAP) and serves as a PAHO/World Health Organization (WHO) Regional Center, with field offices in all the Central American countries, including Belize.2

Occupational Health in Central America

Occupational Health in Central America

Occupational health in Central America.

The 12.4 million economically active population (EAP) of the seven Central American countries includes a large informal sector. Social security covers only 14-60%. No surveillance of occupational safety and health (OSH) hazards or accidents exists. Extrapolating the incidence of occupational accidents among insured Costa Rican workers to the Central American EAP yields two million accidents yearly, still a gross underestimate. Occupational diseases are underreported, misdiagnosed, and not recognized as such. A number of regional OSH programs aim at modernization of the labor administrations and address the formal sector, in particular textile maquila, in connection with free trade agreements. The weak role of the ministries of health is expected to strengthen under the Pan American Health Organization OSH program. Employers largely influence new policies. Workers' influence on OSH policies has been weak, with only about 10% unionization rate and scarce resources and OSH knowledge. Informal workers, however, are getting organized. OSH research is underdeveloped and not linked to policy making. Construction, agriculture, and general un/underemployment are considered priorities for intervention. The informal sector needs to be included in national and regional OSH policies. Regional collaboration and international development support are of strategic importance to achieve sustainable improvement in OSH.