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4 resultados encontrados para: AUTOR: Gagnier, Marielle C
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Background: Results-based aid (RBA) is increasingly used to incentivize action in health. In Mesoamerica, the region consisting of southern Mexico and Central America, the RBA project known as the Salud Mesoamearica Initiative (SMI) was designed to target disparities in maternal and child health, focusing on the poorest 20% of the population across the region. Methods and findings: Data were first collected in 365 intervention health facilities to establish a baseline of indicators. For the first follow-up measure, 18 to 24 months later, 368 facilities were evaluated in these same areas. At both stages, we measured a near-identical set of supply-side performance indicators in line with country-specific priorities in maternal and child health. All countries showed progress in performance indicators, although with different levels. El Salvador, Honduras, Nicaragua, and Panama reached their 18-month targets, while the State of Chiapas in Mexico, Guatemala, and Belize did not. A second follow-up measurement in Chiapas and Guatemala showed continued progress, as they achieved previously missed targets nine to 12 months later, after implementing a performance improvement plan. Conclusions: Our findings show an initial success in the supply-side indicators of SMI. Our data suggest that the RBA approach can be a motivator to improve availability of drugs and services in poor areas. Moreover, our innovative monitoring and evaluation framework will allow health officials with limited resources to identify and target areas of greatest need.


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Timely and accurate measurement of population protection against measles is critical for decision-making and prevention of outbreaks. However, little is known about how surveybased estimates of immunization (crude coverage) compare to the seroprevalence of antibodies (effective coverage), particularly in low-resource settings. In poor areas of Mexico and Nicaragua, we used household surveys to gather information on measles immunization from child health cards and caregiver recall. We also collected dried blood spots (DBS) from children aged 12 to 23 months to compare crude and effective coverage of measles immunization. We used survey-weighted logistic regression to identify individual, maternal, household, community, and health facility characteristics that predict gaps between crude coverage and effective coverage. We found that crude coverage was significantly higher than effective coverage (83% versus 68% in Mexico; 85% versus 50% in Nicaragua). A large proportion of children (19% in Mexico; 43% in Nicaragua) had health card documentation of measles immunization but lacked antibodies. These discrepancies varied from 0% to 100% across municipalities in each country. In multivariate analyses, card-positive children in Mexico were more likely to lack antibodies if they resided in urban areas or the jurisdiction of De Los Llanos. In contrast, card-positive children in Nicaragua were more likely to lack antibodies if they resided in rural areas or the North Atlantic region, had low weight-for-age, or attended health facilities with a greater number of refrigerators. Findings highlight that reliance on child health cards to measure population protection against measles is unwise.

We call for the evaluation of immunization programs using serological methods, especially in poor areas where the cold chain is likely to be compromised. Identification of within-country variation in effective coverage of measles immunization will allow researchers and public health professionals to address challenges in current immunization programs.


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Background: Health has improved markedly in Mesoamerica, the region consisting of southern Mexico and Central America, over the past decade. Despite this progress, there remain substantial inequalities in health outcomes, access, and quality of medical care between and within countries. Poor, indigenous, and rural populations have considerably worse health indicators than national or regional averages. In an effort to address these health inequalities, the Salud Mesoamérica 2015 Initiative (SM2015), a results-based financing initiative, was established. Methods: For each of the eight participating countries, health targets were set to measure the progress of improvements in maternal and child health produced by the Initiative. To establish a baseline, we conducted censuses of 90,000 households, completed 20,225 household interviews, and surveyed 479 health facilities in the poorest areas of Mesoamerica. Pairing health facility and household surveys allows us to link barriers to care and health outcomes with health system infrastructure components and quality of health services. Results: Indicators varied significantly within and between countries. Anemia was most prevalent in Panama and least prevalent in Honduras. Anemia varied by age, with the highest levels observed among children aged 0 to 11 months in all settings. Belize had the highest proportion of institutional deliveries (99%), while Guatemala had the lowest (24%). The proportion of women with four antenatal care visits with a skilled attendant was highest in El Salvador (90%) and the lowest in Guatemala (20%). Availability of contraceptives also varied. The availability of condoms ranged from 83% in Nicaragua to 97% in Honduras. Oral contraceptive pills and injectable contraceptives were available in just 75% of facilities in Panama. IUDs were observed in only 21.5% of facilities surveyed in El Salvador.

Conclusions: These data provide a baseline of much-needed information for evidence-based action on health throughout Mesoamerica. Our baseline estimates reflect large disparities in health indicators within and between countries and will facilitate the evaluation of interventions and investments deployed in the region over the next three to five years. SM2015’s innovative monitoring and evaluation framework will allow health officials with limited resources to identify and target areas of greatest need. Keywords: Results-based financing, Salud Mesoamerica 2015, Vaccination, Contraceptives, Skilled birth attendance, Antenatal care, Anemia, Wasting, Health facilities


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Estimating vaccination coverage is challenging in resource-poor settings where accurate records are sparse. Household surveys, a key source of coverage information, typically capture data from child health cards and rely on maternal recall when cards are unavailable. As a result, little is known about how coverage estimates based on maternal recall differ from those based on health cards for the same children. Furthermore, little is known about how these measures compare with actual rates of seroconversion, which could be used to estimate effective coverage of immunisations. This study compares the accuracy of maternal recall, health card documentation, and antibody presence in vaccination coverage estimates in the state of Chiapas, Mexico. Methods: Data for this study were collected as part of the Mesoamerican Health Initiative 2015 baseline survey. A random sample of 4700 households with children under-5 and women of reproductive age were surveyed. A pre-survey census was carried out within segments that had been randomly selected with probability proportional to size. Standardised multilingual household surveys were implemented using netbooks. Anthropometric measurements were collected for all children under-5 and dry blood spot samples for the detection of measles antibodies were collected from children aged 12—23 months. Findings: Preliminary results suggest that maternal recall, child health cards, and antibody tests generate differing estimates of immunisation coverage. Recall differs from card-based estimates of vaccination coverage by up to 40 percentage points. There are potentially considerable differences in measles immunisation coverage as assessed by the presence of measles antibodies versus other survey sources, highlighting weaknesses in card accuracy, card coverage, and vaccine administration.

Interpretation: Current national estimates of immunisation coverage based on the combination of maternal recall and children's health cards may be overestimating actual protection against vaccine-preventable diseases. Correcting for biases in recall and card coverage may produce more accurate estimates of intervention coverage. Funding: Salud Mesoamerica 2015 is funded by the Bill & Melinda Gates Foundation, the Carlos Slim Health Institute, and the Government of Spain and is administered by the Inter-American Development Bank. The content is solely the responsibility of the authors and does not necessarily represent the official views of the funders or the Inter-American Development Bank.