ABSTRACT Introduction: Reducing poverty and achieving universal health coverage for people of all ages are part of the Sustainable Development Goal. Objective: determine the Out-of-pocket Health Expenditure (GBS) for people 60 and older (≥ 60 years) who are sick and its economic impact on households according to their poverty status in Paraguay. Material and Method: the 2014 Permanent Household Survey was analyzed, considering the official definition of poverty and the reference of illness or accident in a quarter. The average of GBS per household, the impact on quarterly monetary risk (IM) and on state subsidies for food pensions for the elderly (IPa). Results: Of 1,621,525 homes in the country 435,448 had at least 1 person 60 years, of which 188,715 had at least 1 of them ill or injured and 144,554 reported GBS. Among the non-poor households: 11.6% (IC 10.5 to 12.9) had at least 1 ill person ≥ 60 years, of which 75.8% (IC 71.2 to 79.8) had GBS, being on average 547,931 Gs. (DE 58,251). The medications were 53.3% (IC 45.2 to 61.5) from total. There was an IM of 5,7% (IC 4.6 to 6.9). Among the poor households: 11.6% (IC 9.6 to 14.0) had at least 1 ill person ≥ 60 years, of which 79.5% (IC 70.7 to 86,2) had GBS, being on average 341,542 Gs. (DE 40,101). The medications were 71.3 % (IC 61.9 to 80.7) from total. There was an IM of 11.5% (IC 7.0 to 16.0). There was an IPa of 16.9% (IC 4.4 to 29.4). The GBS was the equivalent to 19 days of feeding on average (DE 3.71). Conclusion: Paraguay requires more financial protection for older adults through synergies of poverty reduction and health policies.

RESUMEN Introducción: Reducir la pobreza y lograr cobertura universal de salud con protección financiera para las personas de todas las edades son parte de los Objetivos de Desarrollo Sostenible. Objetivo: Determinar el gasto de bolsillo de salud (GBS) ante la enfermedad de personas de 60 y más años (≥ 60 años) y su incidencia económica en los hogares según su condición de pobreza en Paraguay. Material y Método: Se analizó la Encuesta Permanente de Hogares del 2014, considerando la definición oficial de pobreza y la referencia de enfermedad o accidente en un trimestre. Se calculó el promedio de GBS por hogar, la incidencia sobre el ingreso monetario trimestral (IM) y sobre los subsidios estatales por pensión alimentaria para adultos mayores (IPa). Resultados: De los 1.621.525 hogares del país 435.448 tenía al menos 1 persona ≥ 60 años, de los cuales 188.715 tenía al menos 1 de ellos enfermo o accidentado y 144.554 reportó GBS. Entre los hogares no pobres: 11,6% (IC 10,5 a 12,9) tuvo al menos 1 enfermo ≥ 60 años, de los cuales 75,8% (IC 71,2 a 79,8) tuvo GBS, siendo en promedio 547.931 Gs. (DE 58.251). Los medicamentos fueron 53,3% (IC 45,2 a 61,5) del total. La IM fue 5,7% (IC 4,6 a 6,9). Entre los hogares pobres: 11,6% (IC 9,6 a 14,0) tuvo al menos 1 enfermo ≥ 60 años, de los cuales 79,5% (IC 70,7 a 86,2) tuvo GBS, siendo en promedio 341.542 Gs. (DE 49.101). Los medicamentos fueron 71,3% (IC 61,9 a 80,7) del total. La IM fue 11,5% (IC 7,0 a 16,0), la IPa fue de 16,9% (IC 4,4 a 29,4). El GBS fue el equivalente a 19 días de alimentación en promedio (DE 3,71). Conclusión: Paraguay requiere de mayor protección financiera para adultos mayores mediante sinergias de las políticas de reducción de pobreza y de salud.

RESUMO O presente estudo investigou a ação in vitro dos fungos nematófagos Duddingtonia flagrans (AC001), Monacrosporium thaumasium (NF 34) e Pochonia chlamydosporia (VC1 e VC4) sobre ovos de Eurytrema coelomaticum. Os ovos foram vertidos sobre a superfície de culturas dos isolados fúngicos cultivados sobre ágar-água 2% (AA 2%) em placas de Petri, e sobre AA 2% sem fungo como controle. Ao completarem 7, 10 e 14 dias, os ovos foram removidos e classificados de acordo com os seguintes parâmetros: efeito tipo 1, efeito lítico sem prejuízo morfológico a casca do ovo; tipo 2, efeito lítico com alteração morfológica da casca e embrião; e tipo 3, efeito lítico com alteração morfológica do embrião e da casca, além de penetração de hifas e colonização interna do ovo. Os isolados AC001 e NF34 não causaram os efeitos dos tipos 2 e 3, contudo o isolado VC1 causou tal efeito determinando atividade ovicida sobre 27,2% dos ovos no dia 7, 23,1% no dia 10, e 25,0% no dia 14 após tratamento. Da mesma forma, o isolado VC4 causou atividade ovicida: 15,0%, 25,4%, e 21,8% nos dias 7, 10 e 14, respectivamente. P. chlamydosporia é um fungo promissor para o controle biológico de E. coelomaticum.

ABSTRACT The present study investigated the in-vitro action of the nematophagous fungi Duddingtonia flagrans (AC001), Monacrosporium thaumasium (NF34) and Pochonia chlamydosporia (VC1 and VC4) on eggs of Eurytrema coelomaticum. Eggs were placed on fungal cultures surface over water-agar 2% (WA 2%) in Petri plates, and on WA 2% with no fungus (control). After 7, 10 and 14 days, the eggs were removed and classified according to the following parameters: type 1, lytic effect without morphological damage to eggshell; type 2, lytic effect with morphological alteration of embryo and eggshell; and type 3, lytic effect with morphological alteration of embryo and eggshell, besides hyphal penetration and internal egg colonization. The isolate AC001 and NF34 did not cause the type 2 and 3 effects; however, the isolate VC1 caused the type 3 effect determining the ovicidal activity on 27.2% of eggs at day 7, 23.1% at day 10, and 25.0% at day 14 after treatment. Also, the isolate VC4 caused ovicidal activity: 15.0%, 25.4% and 21.8% at day 7, 10 and 14, respectively. Pochonia chlamydosporia is a promising fungus for biological control of E. coelomaticum.