RESUMO Objetivos. Os países da América Latina e do Caribe obtiveram avanços significativos rumo à consecução do Objetivo de Desenvolvimento Sustentável relacionado à saúde (ODS 3) no nível nacional. No entanto, enormes desigualdades em saúde persistem nos países. Apresenta-se uma linha de base das desigualdades em saúde na região, com referência à qual é possível monitorar o progresso rumo aos ODS. Contexto. Foram estudados 21 países da América Latina e do Caribe usando dados de pesquisas de demografia e saúde e pesquisas de grupos de indicadores múltiplos feitas de 2011 a 2016. Participantes. As pesquisas coletam dados nacionalmente representativos sobre mulheres e crianças, por meio de amostragem multietápica. No total, 288.207 mulheres e 195.092 crianças participaram das pesquisas nos 21 países. Medição dos resultados. Foram estudados cinco indicadores de intervenções de saúde relacionadas à saúde reprodutiva e materna, à fertilidade das adolescentes e às taxas de mortalidade neonatal e de menores de cinco anos. As desigualdades nesses indicadores foram então avaliadas, empregando medidas absolutas e relativas. Resultados. Gradientes geográficos de saúde nos níveis subnacionais foram observados na maioria dos países para quase todos os indicadores referentes às mulheres e à população infantil e adolescente. A cobertura das principais intervenções foi maior nas áreas urbanas e nos quintis mais ricos do que nas áreas rurais e nos quintis mais pobres. As análises por idade das mulheres mostraram que a cobertura das adolescentes era inferior à cobertura das mulheres adultas no que se refere aos indicadores de planejamento familiar. Além disso, foram observadas desigualdades na mortalidade que favoreciam as áreas urbanas e os ricos, na maioria dos países. Conclusões. As médias regionais mascaram desigualdades significativas na saúde entre os países, mas as estimativas nacionais mascaram desigualdades ainda maiores entre os subgrupos de mulheres, crianças e adolescentes. Para alcançar as metas do ODS 3 e não deixar ninguém para trás, é essencial abordar não apenas as lacunas da desigualdade em saúde entre os países, mas também dentro deles.

ABSTRACT Objectives. Latin America and the Caribbean (LAC) countries have made important progress towards achieving the Sustainable Development Goal (SDG) targets related to health (SDG3) at the national level. However, vast within-country health inequalities remain. We present a baseline of health inequalities in the region, against which progress towards the SDGs can be monitored. Setting. We studied 21 countries in LAC using data from Demographic and Health Surveys and Multiple Indicator Cluster Survey carried out from 2011 to 2016. Participants. The surveys collect nationally representative data on women and children using multistage sampling. In total, 288 207 women and 195 092 children made part of the surveys in the 21 countries. Outcome measures. Five health intervention indicators were studied, related to reproductive and maternal health, along with adolescent fertility and neonatal and under-five mortality rates. Inequalities in these indicators were assessed through absolute and relative measures. Results. In most countries, subnational geographical health gradients were observed for nearly all women, child, and adolescent (WCA) indicators. Coverage of key interventions was higher in urban areas and among the richest, compared with rural areas and poorer quintiles. Analyses by woman’s age showed that coverage was lower in adolescent girls than older women for family planning indicators. Pro-urban and pro-rich inequalities were also seen for mortality in most countries. Conclusions. Regional averages hide important health inequalities between countries, but national estimates hide still greater inequalities between subgroups of women, children and adolescents. To achieve the SDG3 targets and leave no one behind, it is essential to close health inequality gaps within as well as between countries.

RESUMEN Objetivos. Los países de América Latina y el Caribe han realizado importantes avances hacia la consecución de las metas del Objetivo de Desarrollo Sostenible relacionado con la salud (ODS 3) a escala nacional. Sin embargo, persisten enormes desigualdades en salud en los países. Se presenta una línea de base de las desigualdades en salud en la región, contra la cual se puede monitorear el progreso hacia los ODS. Contexto. Se estudiaron 21 países de América Latina y el Caribe usando datos de encuestas de demografía y salud y encuestas de indicadores múltiples por conglomerados realizadas del 2011 al 2016. Participantes. En las encuestas se recopilan datos representativos a nivel nacional de mujeres y niños por medio del muestreo polietápico. En total, 288 207 mujeres y 195 092 niños participaron en las encuestas en los 21 países. Medición de los resultados. Se estudiaron cinco indicadores de intervenciones de salud relacionadas con la salud reproductiva y materna, la fecundidad de las adolescentes y las tasas de mortalidad neonatal y de menores de 5 años. Después se evaluaron las desigualdades en estos indicadores por medio de mediciones absolutas y relativas. Resultados. En la mayoría de los países se observaron gradientes geográficos en salud a escala subnacional en casi todos los indicadores correspondientes a las mujeres y la población infantil y adolescente. La cobertura de las principales intervenciones fue mayor en las zonas urbanas y los quintiles más ricos que en las zonas rurales y los quintiles más pobres. Los análisis por edad de la mujer mostraron que la cobertura de las adolescentes era menor que la cobertura de las mujeres adultas en lo que se refiere a los indicadores de planificación familiar. En la mayoría de los países se observaron también desigualdades en la mortalidad que favorecían a las zonas urbanas y a los ricos. Conclusiones. Los promedios regionales ocultan importantes desigualdades en salud entre los países, pero las estimaciones nacionales ocultan desigualdades incluso mayores entre subgrupos de mujeres, niños y adolescentes. Para alcanzar las metas del ODS 3 y no dejar a nadie atrás es esencial subsanar no solo las brechas de la desigualdad en salud entre los países sino también dentro de ellos.

ABSTRACT OBJECTIVE To estimate the prevalence of SARS-CoV-2 antibodies and the adherence to measures of social distancing in children and adolescents studied in three national surveys conducted in Brazil between May–June 2020. METHODS Three national serological surveys were conducted in 133 sentinel cities located in all 27 Federative Units. Multistage probability sampling was used to select 250 individuals per city. The total sample size in age ranges 0–9 and 10–19 years old are of 4,263 and 8,024 individuals, respectively. Information on children or adolescents was gathered with a data collection app, and a rapid point-of-case test for SARS-CoV-2 was conducted on a finger prick blood sample. RESULTS The adjusted prevalence of antibodies was 2.9% (2.2–3.6) among children 0–9 years, 2.2% (1.8–2.6) among adolescents 10-19 years, and 3.0% (2.7–3.3) among adults 20+years. Prevalence of antibodies was higher among poor children and adolescents compared to those of rich families. Adherence to social distancing measures was seen in 72.4% (71.9–73.8) of families with children, 60.8% (59.6–61.9) for adolescents, and 57.4% (56.9–57.8) for adults. For not leaving the house except for essential matters the proportions were 81.7% (80.5–82.9), 70.6% (69.6–61.9), and 65.1% (64.7–65.5), respectively. Among children and adolescents, social distancing was strongly associated with socioeconomic status, being much higher in the better-off families. CONCLUSIONS The prevalence of antibodies against SARS-CoV-2 showed comparable levels among children, adolescents, and adults. Adherence to social distancing measures was more prevalent in children, followed by adolescents. There were important socioeconomic differences in the adherence to social distancing among children and adolescents.

ABSTRACT OBJECTIVE To estimate the prevalence of SARS-CoV-2 antibodies and the adherence to measures of social distancing in children and adolescents studied in three national surveys conducted in Brazil between May–June 2020. METHODS Three national serological surveys were conducted in 133 sentinel cities located in all 27 Federative Units. Multistage probability sampling was used to select 250 individuals per city. The total sample size in age ranges 0–9 and 10–19 years old are of 4,263 and 8,024 individuals, respectively. Information on children or adolescents was gathered with a data collection app, and a rapid point-of-case test for SARS-CoV-2 was conducted on a finger prick blood sample. RESULTS The adjusted prevalence of antibodies was 2.9% (2.2–3.6) among children 0–9 years, 2.2% (1.8–2.6) among adolescents 10-19 years, and 3.0% (2.7–3.3) among adults 20+years. Prevalence of antibodies was higher among poor children and adolescents compared to those of rich families. Adherence to social distancing measures was seen in 72.4% (71.9–73.8) of families with children, 60.8% (59.6–61.9) for adolescents, and 57.4% (56.9–57.8) for adults. For not leaving the house except for essential matters the proportions were 81.7% (80.5–82.9), 70.6% (69.6–61.9), and 65.1% (64.7–65.5), respectively. Among children and adolescents, social distancing was strongly associated with socioeconomic status, being much higher in the better-off families. CONCLUSIONS The prevalence of antibodies against SARS-CoV-2 showed comparable levels among children, adolescents, and adults. Adherence to social distancing measures was more prevalent in children, followed by adolescents. There were important socioeconomic differences in the adherence to social distancing among children and adolescents.

ABSTRACT Background: Large-scale epidemiological studies of seroprevalence of antibodies against SARS-CoV-2 often rely on point-of-care tests that provide immediate results to participants. Yet, little is known on how long rapid tests remain positive after the COVID-19 episode, or how much variability exists across different brands and even among batches of the same test. Methods: In November 2020, we assessed the sensitivity of three tests applied to 133 individuals with a previous positive PCR result between April and October. All subjects provided finger prick blood samples for two batches (A and B) of the Wondfo lateral-flow IgG/IgM test, and dried blood spot samples for the S-UFRJ ELISA test. Results: Overall sensitivity levels were 92.5% (95% CI 86.6-96.3), 63.2% (95% CI 54.4-71.4) and 33.8% (95% CI 25.9-42.5) for the S-UFRJ test, Wondfo A and Wondfo B tests, respectively. There was no evidence of a decline in the positivity of S-UFRJ with time since the diagnosis, but the two Wondfo batches showed sharp reductions to as low as 41.9% and 19.4%, respectively, for subjects with a positive PCR in June or earlier. Positive results for batch B of the rapid test were 35% to 54% lower than for batch A at any given month of diagnosis. Interpretation: Whereas the ELISA test showed high sensitivity and stability of results over the five months of the study, both batches of the rapid test showed substantial declines, with one of the batches consistently showing lower sensitivity levels than the other. ELISA tests based on dried-blood spots are an inexpensive alternative to rapid lateral-flow tests in large-scale epidemiological studies.

ABSTRACT OBJECTIVE To describe the evolution of seropositivity in the State of Rio Grande do Sul, Brazil, through 10 consecutive surveys conducted between April 2020 and April 2021. METHODS Nine cities covering all regions of the State were studied, 500 households in each city. One resident in each household was randomly selected for testing. In survey rounds 1–8 we used the rapid WONDFO SARS-CoV-2 Antibody Test (Wondfo Biotech Co., Guangzhou, China). In rounds 9–10, we used a direct ELISA test that identifies IgG to the viral S protein (S-UFRJ). In terms of social distancing, individuals were asked three questions, from which we generated an exposure score using principal components analysis. RESULTS Antibody prevalence in early April 2020 was 0.07%, increasing to 10.0% in February 2021, and to 18.2% in April 2021. In round 10, self-reported whites showed the lowest seroprevalence (17.3%), while indigenous individuals presented the highest (44.4%). Seropositivity increased by 40% when comparing the most with the least exposed. CONCLUSIONS The proportion of the population already infected by SARS-Cov-2 in the state is still far from any perspective of herd immunity and the infection affects population groups in very different levels.

ABSTRACT OBJECTIVE To describe the evolution of seropositivity in the State of Rio Grande do Sul, Brazil, through 10 consecutive surveys conducted between April 2020 and April 2021. METHODS Nine cities covering all regions of the State were studied, 500 households in each city. One resident in each household was randomly selected for testing. In survey rounds 1–8 we used the rapid WONDFO SARS-CoV-2 Antibody Test (Wondfo Biotech Co., Guangzhou, China). In rounds 9–10, we used a direct ELISA test that identifies IgG to the viral S protein (S-UFRJ). In terms of social distancing, individuals were asked three questions, from which we generated an exposure score using principal components analysis. RESULTS Antibody prevalence in early April 2020 was 0.07%, increasing to 10.0% in February 2021, and to 18.2% in April 2021. In round 10, self-reported whites showed the lowest seroprevalence (17.3%), while indigenous individuals presented the highest (44.4%). Seropositivity increased by 40% when comparing the most with the least exposed. CONCLUSIONS The proportion of the population already infected by SARS-Cov-2 in the state is still far from any perspective of herd immunity and the infection affects population groups in very different levels.

Resumo Objetivo: Verificar a prevalência, mortalidade e fatores de risco associados aos nascimentos de prematuros de muito baixo peso ao nascer (MBPN) ao longo de 33 anos. Métodos: Série de quatro estudos transversais com o uso de dados das entrevistas perinatais das coortes de nascimento da cidade de Pelotas coletados em 1982, 1993, 2004 e 2015. A partir de questionários perinatais, medidas antropométricas dos recém-nascidos e certidões de óbito, foram analisadas a prevalência, a mortalidade neonatal e os fatores de risco (idade materna, renda e tipo de parto) para prematuros de muito baixo peso ao nascer. Resultados: Foram incluídos no estudo 19.625 recém-nascidos. Em 1982, 1993, 2004 e 2015 ocorreram, respectivamente, 5.909, 5.232, 4.226 e 4.258 nascimentos. A prevalência de prematuros de muito baixo peso ao nascer naqueles anos foi, respectivamente, de 1,1% (n = 64), 0,9% (n = 46), 1,4% (n = 61) e 1,3% (n = 54). A tendência de aumento durante o período não alcançou significância estatística (p = 0,11). Entre os fatores de risco, a renda familiar nos três quintis mais pobres esteve associada a prevalências cerca de duas vezes mais altas do que no quintil mais rico (p = 0,003). A mortalidade por 1.000 nascidos vivos para os neonatos com peso < 1500 g caiu de 688 para 259 por mil ao longo dos anos (p < 0,001), mas ainda representa 61% dos óbitos neonatais em 2015. Conclusão: Embora a mortalidade nos prematuros de muito baixo peso ao nascer tenha diminuído em mais de 60% nos últimos anos, esse grupo ainda contribui com mais da metade dos óbitos neonatais. A baixa renda familiar continua a ser fator de risco importante nesse cenário.

Abstract Objective: To assess the prevalence, mortality and risk factors associated with the birth of very low birth weight preterm infants over a period of 33 years. Methods: Four cross-sectional studies were analyzed, using data from perinatal interviews of birth cohorts in the city of Pelotas collected in 1982, 1993, 2004, and 2015. Based on perinatal questionnaires, anthropometric measurements of newborns and death certificates were analyzed to obtain the prevalence rate, neonatal mortality, and risk factors (maternal age, income and type of delivery) for very low birth weight. Results: A total of 19,625 newborns were included in the study. In the years 1982, 1993, 2004, and 2015, there were, respectively, 5909, 5232, 4226, and 4258 births. The prevalence of very low birth weight was, respectively, 1.1% (n = 64), 0.9% (n = 46), 1.4% (n = 61), and 1.3% (n = 54). There was no statistical evidence of an increasing trend over time (p = 0.11). Among the risk factors, family income in the three poorest quintiles was associated with prevalence rates that were approximately twice as high as in the richest quintile (p = 0.003). Mortality per 1000 live births for neonates weighing <1500 g decreased from 688 to 259 per thousand from 1982 to 2015 (p < 0.001), but still represented 61% of neonatal deaths in the latter year. Conclusion: Although mortality in very low birth weight decreased by more than 60% in recent years, this group still contributes with more than half of neonatal deaths. Low family income remains an important risk factor in this scenario.

RESUMO OBJETIVO Descrever práticas de distanciamento social em nove municípios do Rio Grande do Sul por sexo, idade, escolaridade e cidade. MÉTODOS Foram realizados dois estudos transversais sequenciais representativos da população urbana nos municípios de Canoas, Caxias do Sul, Ijuí, Passo Fundo, Pelotas, Porto Alegre, Santa Cruz do Sul, Santa Maria e Uruguaiana com o intuito de estimar a prevalência populacional de Covid-19. Foi aplicado questionário contendo três perguntas sobre distanciamento social, cujas práticas foram submetidas a análises descritivas por subgrupos. Os dados foram comparados por testes qui-quadrado. RESULTADOS Em termos de grau de distanciamento social, 25,8% dos entrevistados relataram estar praticamente isolados e 41,1% indicam praticar bastante distanciamento. Relataram ficar em casa o tempo todo 20,1% dos entrevistados, e 44,5% informam que saem apenas para atividades essenciais. Mais da metade dos domicílios não recebe visitas de não moradores. O grupo que relatou menos distanciamento social foi o de adultos entre 20 e 59 anos, enquanto mais de 80% dos entrevistados com 60 anos ou mais relataram estar praticamente isolados ou fazendo bastante distanciamento. As mulheres relataram fazer mais distanciamento que os homens, e os grupos de maior escolaridade foram os que relataram sair diariamente para atividades regulares com mais frequência. CONCLUSÕES Os grupos mais jovens e mais idosos estão mais protegidos pelo distanciamento social, mas há grupos bastante expostos, o que pode ser um limitador importante no controle da progressão da epidemia de Covid-19.

ABSTRACT OBJECTIVE To describe social distancing practices in nine municipalities of the state of Rio Grande do Sul, Brazil, stratified by gender, age, and educational attainment. METHODS Two sequential cross-sectional studies were conducted in the municipalities of Canoas, Caxias do Sul, Ijuí, Passo Fundo, Pelotas, Porto Alegre, Santa Cruz do Sul, Santa Maria, and Uruguaiana to estimate the population prevalence of COVID-19. The study was designed to be representative of the urban population of these municipalities. A questionnaire including three questions about social distancing was also administered to the participants. Here, we present descriptive analyses of social distancing practices by subgroups and use chi-square tests for comparisons. RESULTS In terms of degree of social distancing, 25.8% of the interviewees reported being essentially isolated and 41.1% reported being quite isolated. 20.1% of respondents reported staying at home all the time, while 44.5% left only for essential activities. More than half of households reported receiving no visits from non-residents. Adults aged 20 to 59 reported the least social distancing, while more than 80% of participants aged 60 years or older reported being essentially isolated or quite isolated. Women reported more stringent distancing than men. Groups with higher educational attainment reported going out for daily activities more frequently. CONCLUSIONS The extremes of age are more protected by social distancing, but some groups remain highly exposed. This can be an important limiting factor in controlling progression of the COVID-19 pandemic.

RESUMO OBJETIVO Descrever práticas de distanciamento social em nove municípios do Rio Grande do Sul por sexo, idade, escolaridade e cidade. MÉTODOS Foram realizados dois estudos transversais sequenciais representativos da população urbana nos municípios de Canoas, Caxias do Sul, Ijuí, Passo Fundo, Pelotas, Porto Alegre, Santa Cruz do Sul, Santa Maria e Uruguaiana com o intuito de estimar a prevalência populacional de Covid-19. Foi aplicado questionário contendo três perguntas sobre distanciamento social, cujas práticas foram submetidas a análises descritivas por subgrupos. Os dados foram comparados por testes qui-quadrado. RESULTADOS Em termos de grau de distanciamento social, 25,8% dos entrevistados relataram estar praticamente isolados e 41,1% indicam praticar bastante distanciamento. Relataram ficar em casa o tempo todo 20,1% dos entrevistados, e 44,5% informam que saem apenas para atividades essenciais. Mais da metade dos domicílios não recebe visitas de não moradores. O grupo que relatou menos distanciamento social foi o de adultos entre 20 e 59 anos, enquanto mais de 80% dos entrevistados com 60 anos ou mais relataram estar praticamente isolados ou fazendo bastante distanciamento. As mulheres relataram fazer mais distanciamento que os homens, e os grupos de maior escolaridade foram os que relataram sair diariamente para atividades regulares com mais frequência. CONCLUSÕES Os grupos mais jovens e mais idosos estão mais protegidos pelo distanciamento social, mas há grupos bastante expostos, o que pode ser um limitador importante no controle da progressão da epidemia de Covid-19.

ABSTRACT OBJECTIVE To describe social distancing practices in nine municipalities of the state of Rio Grande do Sul, Brazil, stratified by gender, age, and educational attainment. METHODS Two sequential cross-sectional studies were conducted in the municipalities of Canoas, Caxias do Sul, Ijuí, Passo Fundo, Pelotas, Porto Alegre, Santa Cruz do Sul, Santa Maria, and Uruguaiana to estimate the population prevalence of COVID-19. The study was designed to be representative of the urban population of these municipalities. A questionnaire including three questions about social distancing was also administered to the participants. Here, we present descriptive analyses of social distancing practices by subgroups and use chi-square tests for comparisons. RESULTS In terms of degree of social distancing, 25.8% of the interviewees reported being essentially isolated and 41.1% reported being quite isolated. 20.1% of respondents reported staying at home all the time, while 44.5% left only for essential activities. More than half of households reported receiving no visits from non-residents. Adults aged 20 to 59 reported the least social distancing, while more than 80% of participants aged 60 years or older reported being essentially isolated or quite isolated. Women reported more stringent distancing than men. Groups with higher educational attainment reported going out for daily activities more frequently. CONCLUSIONS The extremes of age are more protected by social distancing, but some groups remain highly exposed. This can be an important limiting factor in controlling progression of the COVID-19 pandemic.

Objective To examine temporal trends in caesarean delivery rates in southern Asia and sub-Saharan Africa, by country and wealth quintile. Methods Cross-sectional data were extracted from the results of 80 Demographic and Health Surveys conducted in 26 countries in southern Asia or sub-Saharan Africa. Caesarean delivery rates were evaluated – as percentages of the deliveries that ended in live births – for each wealth quintile in each survey. The annual rates recorded for each country were then compared to see if they had increased over time. Findings Caesarean delivery rates had risen over time in all but 6 study countries but were consistently found to be lower than 5% in 18 of the countries and 10% or less in the other eight countries. Among the poorest 20% of the population, caesarean sections accounted for less than 1% and less than 2% of deliveries in 12 and 21 of the study countries, respectively. In each of 11 countries, the caesarean delivery rate in the poorest 40% of the population remained under 1%. In Chad, Ethiopia, Guinea, Madagascar, Mali, Mozambique, Niger and Nigeria, the rate remained under 1% in the poorest 80%. Compared with the 22 African study countries, the four study countries in southern Asia experienced a much greater rise in their caesarean delivery rates over time. However, the rates recorded among the poorest quintile in each of these countries consistently fell below 2%. Conclusion Caesarean delivery rates among large sections of the population in sub-Saharan Africa are very low, probably because of poor access to such surgery.

Resumen Objetivo Analizar las tendencias temporales de las tasas de parto por cesárea en Asia meridional y África subsahariana, por país y por quintil de riqueza. Métodos Se obtuvieron datos transversales de los resultados de 80 encuestas de demografía y salud realizadas en 26 países de Asia meridional y África subsahariana. Se evaluaron las tasas de parto por cesárea, como porcentaje de los partos que terminaron en nacimientos vivos, en cada quintil de ingresos en cada encuesta. Se compararon las tasas anuales registradas de cada país para comprobar si habían aumentado con el tiempo. Resultados Las tasas de parto por cesárea han aumentado con el tiempo en todos los países de estudio, excepto seis. Sin embargo, se halló que las tasas son sistemáticamente inferiores al 5% en 18 de los países y al 10% o menos en los otros ocho países. Entre el 20% de la población más pobre, las cesáreas representaron menos del 1% y menos del 2% de los partos en 12 y 21 de los países de estudio, respectivamente. En cada uno de los 11 países, la tasa de parto por cesárea del 40% de la población pobre se mantuvo por debajo del 1%. En el Chad, Etiopía, Guinea, Madagascar, Malí, Mozambique, Níger y Nigeria, la tasa se mantuvo por debajo del 1% en el 80% de la población pobre. En comparación con los 22 países africanos de estudio, los cuatro países de estudio de Asia meridional experimentaron un mayor aumento en sus tasas de parto por cesárea a lo largo del tiempo. Sin embargo, las tasas registradas en el quintil más pobre de cada uno de estos países se redujeron de forma constante por debajo del 2%. Conclusión Las tasas de parto por cesárea en amplios sectores de la población del África subsahariana son muy bajas, probablemente debido a la falta de acceso a este tipo de cirugía.

Résumé Objectif Examiner les tendances temporelle des taux d'accouchement par césarienne en Asie du Sud et en Afrique sub-saharienne, par pays et quintile de richesse. Méthodes Les données transversales ont été extraites des résultats de 80 Enquêtes Démographiques et Sanitaires menées dans 26 pays en Asie du Sud ou en Afrique sub-saharienne. Les taux d'accouchement par césarienne ont été évalués – sous forme de pourcentages des accouchements qui ont abouti à une naissance vivante – pour chaque quintile de richesse dans chaque enquête. Les taux annuels enregistrés pour chaque pays ont alors été comparés pour voir s'ils avaient augmenté au fil du temps. Résultats Les taux d'accouchement par césarienne ont augmenté au fil du temps dans l'ensemble des pays étudiés, sauf six, mais ils sont systématiquement inférieurs à 5% dans 18 des pays et inférieurs ou égaux à 10% dans 8 autres pays. Parmi la couche des 20% les plus pauvres de la population, les césariennes représentaient moins de 1% et moins de 2% des accouchements dans, respectivement, 12 et 21 pays étudiés. Dans chacun des 11 pays, le taux d'accouchement par césarienne dans la couche des 40% les plus pauvres de la population est resté sous 1%. Au Tchad, en Éthiopie, en Guinée, à Madagascar, au Mali, au Mozambique, au Niger et au Nigéria, le taux est resté sous 1% dans la couche des 80% les plus pauvres. Si l'on compare avec les 22 pays africains étudiés, les 4 pays étudiés en Asie du Sud ont connu une plus grande augmentation de leur taux d'accouchement par césarienne au fil du temps. Cependant, les taux enregistrés au sein du quintile le plus pauvre dans chacun de ces pays chute systématiquement sous 2%. Conclusion Les taux d'accouchement par césarienne au sein de larges couches de la population en Afrique sub-saharienne sont très faibles, probablement à cause du manque d'accès à un tel acte chirurgical.

OBJECTIVE: To measure within-country wealth-related inequality in the health service coverage gap of maternal and child health indicators in sub-Saharan Africa and quantify its contribution to the national health service coverage gap. METHODS: Coverage data for child and maternal health services in 28 sub-Saharan African countries were obtained from the 2000-2008 Demographic Health Survey. For each country, the national coverage gap was determined for an overall health service coverage index and select individual health service indicators. The data were then additively broken down into the coverage gap in the wealthiest quintile (i.e. the proportion of the quintile lacking a required health service) and the population attributable risk (an absolute measure of within-country wealth-related inequality). FINDINGS: In 26 countries, within-country wealth-related inequality accounted for more than one quarter of the national overall coverage gap. Reducing such inequality could lower this gap by 16% to 56%, depending on the country. Regarding select individual health service indicators, wealth-related inequality was more common in services such as skilled birth attendance and antenatal care, and less so in family planning, measles immunization, receipt of a third dose of vaccine against diphtheria, pertussis and tetanus and treatment of acute respiratory infections in children under 5 years of age. CONCLUSION: The contribution of wealth-related inequality to the child and maternal health service coverage gap differs by country and type of health service, warranting case-specific interventions. Targeted policies are most appropriate where high within-country wealth-related inequality exists, and whole-population approaches, where the health-service coverage gap is high in all quintiles.

OBJETIVO : Medir la desigualdad en cuanto a la riqueza de cada país con respecto a las carencias en la cobertura del servicio sanitario de los indicadores de salud materno-infantil en el África subsahariana y cuantificar su contribución a las carencias de cobertura en los servicios sanitarios nacionales. MÉTODOS: A través de la Encuesta sobre Salud y Demografía de 2000-2008 se obtuvieron los datos de cobertura de los servicios sanitarios materno-infantiles en 28 países del África subsahariana. Para cada uno de los países se determinaron las carencias de cobertura nacional para un índice de cobertura global de servicios sanitarios y para indicadores de servicios sanitarios individuales. Los datos se separaron además en las carencias de cobertura para el quintil más rico (por ejemplo, la proporción del quintil que carecía del servicio sanitario necesario) y el riesgo atribuible a la población (una medida absoluta de la desigualdad en cuanto a riqueza de cada país). RESULTADO: En 26 países, la desigualdad nacional en cuanto a la riqueza, constituyó más de un cuarto de las carencias de cobertura total del país. Si se redujera dicha desigualdad, estas carencias disminuirían entre un 16% y un 56%, dependiendo del país. En cuanto a los indicadores de servicios sanitarios individuales, la desigualdad en cuanto a riqueza fue más palpable en servicios como la asistencia profesional al parto y la asistencia prenatal, y menos destacada en la planificación familiar, la vacunación contra el sarampión, la recepción de una tercera dosis de la vacuna contra la difteria, la tos ferina y el tétano y en el tratamiento de infecciones respiratorias agudas en niños menores de 5 años. CONCLUSIÓN: La contribución de la desigualdad en cuanto a riqueza en las carencias de cobertura de servicios sanitarios materno-infantiles varía en cada país y según el servicio sanitario, por lo que necesita intervenciones específicas para cada caso. Las normativas específicas son las más adecuadas cuando se producen casos de marcada desigualdad en cuanto a riqueza dentro de un país, y los enfoques globales, para aquellos países con unas carencias de cobertura de servicios elevadas en todos los quintiles de población.

OBJECTIF: Mesurer l'inégalité intra-nationale liée à la richesse dans l'écart de couverture sanitaire d'indicateurs de santé maternelle et infantile en Afrique sub-saharienne et quantifier sa contribution à l'écart national de couverture sanitaire. MÉTHODES: Les données de couverture sanitaire maternelle et infantile dans 28 pays d'Afrique sub-saharienne ont été tirées de l'Enquête démographique et sanitaire de 2000-2008. Pour chaque pays, l'écart national de couverture a été déterminé pour un indice de couverture sanitaire globale et pour des indicateurs sanitaires spécifiques. Les données ont ensuite été ventilées de manière additive dans l'écart de couverture dans le quintile le plus riche (soit la proportion du quintile sans service sanitaire requis) et le risque imputable à la population (une mesure absolue de l'inégalité intra-nationale liée à la richesse). RÉSULTANTS: Dans 26 pays, l'inégalité intra-nationale de richesse explique plus d'un quart de l'écart national de couverture globale. Réduire cette inégalité pourrait réduire cet écart de 16% à 56%, selon les pays. Pour les indicateurs sanitaires spécifiques, l'inégalité liée à la richesse était plus fréquente dans des services comme les services d'accouchement et de soins prénatals qualifiés, et moins fréquente pour la planification familiale, la vaccination contre la rougeole, l'administration de la troisième dose de vaccin contre la diphtérie, la coqueluche et le tétanos et le traitement des infections respiratoires aiguës chez les enfants de moins de 5 ans. CONCLUSION: L'impact de l'inégalité de richesse sur l'écart de couverture sanitaire maternelle et infantile diffère selon les pays et le type de service sanitaire, justifiant des interventions au cas par cas. Des politiques ciblées sont plus appropriées quand l'inégalité de richesse intra-nationale est élevée, et des approches visant l'ensemble de la population quand l'écart de couverture sanitaire est élevé dans tous les quintiles.

OBJETIVO: Descrever o padrão dos partos em uma coorte de nascimentos, comparando partos normais e cesarianos. MÉTODOS: Todos os recém-nascidos de moradoras da área urbana de Pelotas (RS) em 2004 foram recrutados para uma coorte de nascimentos. As mães foram entrevistadas ainda no hospital, quando informações detalhadas sobre a gestação, o parto e o recém-nascido, junto com um histórico da saúde materna e características da família foram coletadas. Características maternas e o financiamento do parto foram os principais fatores estudados. Também se fez uma descrição da distribuição das cesáreas por hora do dia e dia da semana. Técnicas padrão de análise descritiva e testes qui-quadrado para comparar proporções e regressão Poisson para explorar o efeito independente de preditores da cesárea foram os métodos utilizados. RESULTADOS: A taxa global de cesarianas foi de 45%, 36% entre pacientes do SUS e 81% no serviço privado, onde se relatou que 35% das cesarianas foram eletivas. As cesarianas foram mais freqüentes nas terças e quartas-feiras, com uma redução de cerca de um terço aos domingos, enquanto os partos normais apresentaram distribuição uniforme ao longo da semana. O horário das cesarianas no setor público e no privado foi muito diferente. A escolaridade materna se associou positivamente com a cesariana entre as mães do serviço público, mas não do privado. CONCLUSÕES: A cesariana foi muito freqüente entre as mães mais ricas, e fortemente associada com a escolaridade materna entre pacientes do SUS. Os padrões descritos são compatíveis com a hipótese de que as cesáreas são feitas, em grande parte, para atender a conveniência das agendas dos médicos. A situação atual só será revertida com políticas radicais.

OBJECTIVE: To describe the patterns of deliveries in a birth cohort and to compare vaginal and cesarean section deliveries. METHODS: All children born to mothers from the urban area of Pelotas, Brazil, in 2004, were recruited for a birth cohort study. Mothers were contacted and interviewed during their hospital stay when extensive information on the gestation, the birth and the newborn, along with maternal health history and family characteristics was collected. Maternal characteristics and childbirth care financing - either private or public healthcare (SUS) patients - were the main factors investigated along with a description of C-sections distribution according to day of the week and delivery time. Standard descriptive techniques, Χ² tests for comparing proportions and Poisson regression to explore the independent effect of C-section predictors were the methods used. RESULTS: The overall C-section rate was 45%, 36% among SUS and 81% among private patients, where 35% of C-sections were reported elective. C-sections were more frequent on Tuesdays and Wednesdays, reducing by about a third on Sundays, while normal deliveries had a uniform distribution along the week. Delivery time for C-sections was markedly different among public and private patients. Maternal schooling was positively associated with C-section among SUS patients, but not among private patients. CONCLUSIONS: C-sections were almost universal among the wealthier mothers, and strongly related to maternal education among SUS patients. The patterns we describe are compatible with the idea that C-sections are largely done to suit the doctor's schedule. Drastic action is called for to change the current situation.

OBJETIVO: Describir el padrón de los partos en una cohorte de nacimientos, comparando partos normales y cesáreos. MÉTODOS: Todos los recién nacidos de moradoras de área urbana de Pelotas (Sur de Brasil) en 2004 fueron reclutados para una cohorte de nacimientos. Las madres fueron entrevistadas aún en el hospital, cuando informaciones detalladas de la gestación, el parto y el recién nacido, junto con una historia de salud materna y características de la familia fueron colectadas. Características maternas y el financiamiento del parto fueron los principales factores estudiados. También se hizo descripción de la distribución de las cesáreas por hora del día y día de la semana. Técnicas de padrón de análisis descriptivo y pruebas chi-cuadrado para comparar proporciones y regresión Poisson para explorar el efecto independiente de predictores de la cesárea fueron los métodos utilizados. RESULTADOS: La tasa global de cesáreas fue de 45%, 36% entre pacientes del servicio público y 81% en el servicio privado, donde se relató que 35% de las cesáreas fueron electivas. Las cesáreas fueron más frecuentes martes y miércoles, con una reducción de cerca de un tercio los domingos, mientras que los partos normales presentaron distribución uniforme a lo largo de la semana. El horario de las cesáreas en el servicio público y en el privado fue muy diferente. La escolaridad materna se asoció positivamente con la cesárea entre las madres del servicio público, pero no del privado. CONCLUSIONES: La cesárea fue muy frecuente entre las madres más ricas, y fuertemente asociada con la escolaridad materna entre pacientes del servicio público. Los padrones descritos son compatibles con la hipótesis de que las cesáreas son hechas, en gran parte, para atender la conveniencia de las agendas de los médicos. La situación actual sólo será revertida con políticas radicales.

OBJETIVO: Descrever o padrão dos partos em uma coorte de nascimentos, comparando partos normais e cesarianos. MÉTODOS: Todos os recém-nascidos de moradoras da área urbana de Pelotas (RS) em 2004 foram recrutados para uma coorte de nascimentos. As mães foram entrevistadas ainda no hospital, quando informações detalhadas sobre a gestação, o parto e o recém-nascido, junto com um histórico da saúde materna e características da família foram coletadas. Características maternas e o financiamento do parto foram os principais fatores estudados. Também se fez uma descrição da distribuição das cesáreas por hora do dia e dia da semana. Técnicas padrão de análise descritiva e testes qui-quadrado para comparar proporções e regressão Poisson para explorar o efeito independente de preditores da cesárea foram os métodos utilizados. RESULTADOS: A taxa global de cesarianas foi de 45%, 36% entre pacientes do SUS e 81% no serviço privado, onde se relatou que 35% das cesarianas foram eletivas. As cesarianas foram mais freqüentes nas terças e quartas-feiras, com uma redução de cerca de um terço aos domingos, enquanto os partos normais apresentaram distribuição uniforme ao longo da semana. O horário das cesarianas no setor público e no privado foi muito diferente. A escolaridade materna se associou positivamente com a cesariana entre as mães do serviço público, mas não do privado. CONCLUSÕES: A cesariana foi muito freqüente entre as mães mais ricas, e fortemente associada com a escolaridade materna entre pacientes do SUS. Os padrões descritos são compatíveis com a hipótese de que as cesáreas são feitas, em grande parte, para atender a conveniência das agendas dos médicos. A situação atual só será revertida com políticas radicais.

OBJECTIVE: To describe the patterns of deliveries in a birth cohort and to compare vaginal and cesarean section deliveries. METHODS: All children born to mothers from the urban area of Pelotas, Brazil, in 2004, were recruited for a birth cohort study. Mothers were contacted and interviewed during their hospital stay when extensive information on the gestation, the birth and the newborn, along with maternal health history and family characteristics was collected. Maternal characteristics and childbirth care financing - either private or public healthcare (SUS) patients - were the main factors investigated along with a description of C-sections distribution according to day of the week and delivery time. Standard descriptive techniques, Χ² tests for comparing proportions and Poisson regression to explore the independent effect of C-section predictors were the methods used. RESULTS: The overall C-section rate was 45%, 36% among SUS and 81% among private patients, where 35% of C-sections were reported elective. C-sections were more frequent on Tuesdays and Wednesdays, reducing by about a third on Sundays, while normal deliveries had a uniform distribution along the week. Delivery time for C-sections was markedly different among public and private patients. Maternal schooling was positively associated with C-section among SUS patients, but not among private patients. CONCLUSIONS: C-sections were almost universal among the wealthier mothers, and strongly related to maternal education among SUS patients. The patterns we describe are compatible with the idea that C-sections are largely done to suit the doctor's schedule. Drastic action is called for to change the current situation.

OBJETIVO: Describir el padrón de los partos en una cohorte de nacimientos, comparando partos normales y cesáreos. MÉTODOS: Todos los recién nacidos de moradoras de área urbana de Pelotas (Sur de Brasil) en 2004 fueron reclutados para una cohorte de nacimientos. Las madres fueron entrevistadas aún en el hospital, cuando informaciones detalladas de la gestación, el parto y el recién nacido, junto con una historia de salud materna y características de la familia fueron colectadas. Características maternas y el financiamiento del parto fueron los principales factores estudiados. También se hizo descripción de la distribución de las cesáreas por hora del día y día de la semana. Técnicas de padrón de análisis descriptivo y pruebas chi-cuadrado para comparar proporciones y regresión Poisson para explorar el efecto independiente de predictores de la cesárea fueron los métodos utilizados. RESULTADOS: La tasa global de cesáreas fue de 45%, 36% entre pacientes del servicio público y 81% en el servicio privado, donde se relató que 35% de las cesáreas fueron electivas. Las cesáreas fueron más frecuentes martes y miércoles, con una reducción de cerca de un tercio los domingos, mientras que los partos normales presentaron distribución uniforme a lo largo de la semana. El horario de las cesáreas en el servicio público y en el privado fue muy diferente. La escolaridad materna se asoció positivamente con la cesárea entre las madres del servicio público, pero no del privado. CONCLUSIONES: La cesárea fue muy frecuente entre las madres más ricas, y fuertemente asociada con la escolaridad materna entre pacientes del servicio público. Los padrones descritos son compatibles con la hipótesis de que las cesáreas son hechas, en gran parte, para atender la conveniencia de las agendas de los médicos. La situación actual sólo será revertida con políticas radicales.

OBJETIVO: Estimar a prevalência de recém-nascidos pré-termo entre os recém-nascidos de baixo peso ao nascer de países de renda média ou baixa. MÉTODOS: Em consulta a bases de dados (PubMed, LILACS, Google Scholar) foram procurados estudos sobre a prevalência de recém-nascidos a termo e pré-termo entre aqueles de baixo peso ao nascer conduzidos após 1990 em países emergentes. Modelos de regressão foram usados para avaliar a proporção de acordo com as prevalências de baixo peso. RESULTADOS: Com base em 47 estudos de 27 países emergentes, aproximadamente metade de todos os recém-nascidos com baixo peso seriam prematuros, em vez de um a cada três, como estimado em estudos anteriores à década de 1990. CONCLUSÕES: A estimativa de números substancialmente mais altos de prematuros com baixo peso tem importantes reflexos no planejamento em saúde, uma vez que esses recém-nascidos demandam cuidados especiais. Todavia, os achados são limitados pela falta de estudos populacionais.

OBJECTIVE: To assess the prevalence of preterm birth among low birthweight babies in low and middle-income countries. METHODS: Major databases (PubMed, LILACS, Google Scholar) were searched for studies on the prevalence of term and preterm LBW babies with field work carried out after 1990 in low- and middle-income countries. Regression methods were used to model this proportion according to LBW prevalence levels. RESULTS: According to 47 studies from 27 low- and middle-income countries, approximately half of all LBW babies are preterm rather than one in three as assumed in studies previous to the 1990s. CONCLUSIONS: The estimate of a substantially higher number of LBW preterm babies has important policy implications in view of special health care needs of these infants. As for earlier projections, our findings are limited by the relative lack of population-based studies.

OBJETIVO: Estimar la prevalencia de recién nacidos pre-término entre los recién nacidos de bajo peso al nacer de países de renta media o baja. MÉTODOS: En consulta a bases de datos (PubMed, LILACS, Google Scholar) fueron procurados estudios sobre la prevalencia de recién nacidos a término y pre-término entre aquellos de bajo peso al nacer conducidos posteriores a 1990 en países emergentes. Modelos de regresión fueron usados para evaluar la proporción de acuerdo con las prevalencias de bajo peso. RESULTADOS: Con base en 47 estudios de 27 países emergentes, aproximadamente la mitad de todos los recién nacidos con bajo peso serían prematuros, y no uno de cada tres, como se estimó en estudios anteriores a la década de 1990. CONCLUSIONES: La estimación de números sustancialmente más altos de prematuros con bajo peso tiene importantes consecuencias en la planificación de salud, ya que tales recién nacidos demandan cuidados especiales. Aún, los resultados son limitados por la falta de estudios poblacionales.

OBJETIVO: Estimar a prevalência de recém-nascidos pré-termo entre os recém-nascidos de baixo peso ao nascer de países de renda média ou baixa. MÉTODOS: Em consulta a bases de dados (PubMed, LILACS, Google Scholar) foram procurados estudos sobre a prevalência de recém-nascidos a termo e pré-termo entre aqueles de baixo peso ao nascer conduzidos após 1990 em países emergentes. Modelos de regressão foram usados para avaliar a proporção de acordo com as prevalências de baixo peso. RESULTADOS: Com base em 47 estudos de 27 países emergentes, aproximadamente metade de todos os recém-nascidos com baixo peso seriam prematuros, em vez de um a cada três, como estimado em estudos anteriores à década de 1990. CONCLUSÕES: A estimativa de números substancialmente mais altos de prematuros com baixo peso tem importantes reflexos no planejamento em saúde, uma vez que esses recém-nascidos demandam cuidados especiais. Todavia, os achados são limitados pela falta de estudos populacionais.

OBJECTIVE: To assess the prevalence of preterm birth among low birthweight babies in low and middle-income countries. METHODS: Major databases (PubMed, LILACS, Google Scholar) were searched for studies on the prevalence of term and preterm LBW babies with field work carried out after 1990 in low- and middle-income countries. Regression methods were used to model this proportion according to LBW prevalence levels. RESULTS: According to 47 studies from 27 low- and middle-income countries, approximately half of all LBW babies are preterm rather than one in three as assumed in studies previous to the 1990s. CONCLUSIONS: The estimate of a substantially higher number of LBW preterm babies has important policy implications in view of special health care needs of these infants. As for earlier projections, our findings are limited by the relative lack of population-based studies.

OBJETIVO: Estimar la prevalencia de recién nacidos pre-término entre los recién nacidos de bajo peso al nacer de países de renta media o baja. MÉTODOS: En consulta a bases de datos (PubMed, LILACS, Google Scholar) fueron procurados estudios sobre la prevalencia de recién nacidos a término y pre-término entre aquellos de bajo peso al nacer conducidos posteriores a 1990 en países emergentes. Modelos de regresión fueron usados para evaluar la proporción de acuerdo con las prevalencias de bajo peso. RESULTADOS: Con base en 47 estudios de 27 países emergentes, aproximadamente la mitad de todos los recién nacidos con bajo peso serían prematuros, y no uno de cada tres, como se estimó en estudios anteriores a la década de 1990. CONCLUSIONES: La estimación de números sustancialmente más altos de prematuros con bajo peso tiene importantes consecuencias en la planificación de salud, ya que tales recién nacidos demandan cuidados especiales. Aún, los resultados son limitados por la falta de estudios poblacionales.