RESUMEN
The World Health Organization (WHO) has established a target to eliminate mother-to-child-transmission (EMTCT) of hepatitis B virus (HBV), defined as a prevalence of hepatitis B surface antigen (HBsAg) of ≤0.1% among children, by 2030. Using nationally representative serosurveys to verify achievement of this target requires large sample sizes and significant resources. We assessed the feasibility of a potentially more efficient two-phase method to verify EMTCT of HBV in Colombia. In the first phase, we conducted a risk assessment to identify municipalities at the highest risk of ongoing HBV transmission. We ranked the 1122 municipalities of Colombia based on the reports of HBV infection in pregnant women per 1000 population. Municipalities with ≥0.3 reports per 1000 persons (equating to the top quartile) were further assessed based on health facility birth rates, coverage with three doses of hepatitis B vaccine (HepB3) and seroprevalence data. Hepatitis B risk was considered to be further increased for municipalities with HepB3 coverage or health facility birth rate <90%. In the second phase, we conducted a multistage household serosurvey of children aged 5-10 years in 36 municipalities with the highest assessed HBV risk. HBsAg was not detected in any of 3203 children tested, yielding a 90% upper confidence bound of <0.1% prevalence. Coverage with HepB3 and hepatitis B birth dose was high at 97.5% and 95.6%, respectively. These results support the conclusion that Colombia has likely achieved EMTCT of HBV.
Asunto(s)
Hepatitis B , Transmisión Vertical de Enfermedad Infecciosa , Colombia/epidemiología , Femenino , Hepatitis B/epidemiología , Hepatitis B/prevención & control , Antígenos de Superficie de la Hepatitis B , Vacunas contra Hepatitis B , Virus de la Hepatitis B , Humanos , Transmisión Vertical de Enfermedad Infecciosa/prevención & control , Embarazo , Prevalencia , Estudios SeroepidemiológicosRESUMEN
Resumen Objetivo: Esta investigación explora las percepciones, actitudes y prácticas de niñas, niños y adolescentes sobre violencias en los entornos familiar y escolar. Metodología: Durante 2018, se aplicó una encuesta sobre sexualidad, convivencia familiar y entorno escolar a 16 558 niñas, niños y adolescentes escolarizados de entre 9 y 19 años de edad, habitantes de ocho municipios de Colombia, de las zonas Caribe y Pacífico. Resultados: Se encontraron porcentajes altos de violencia en el hogar y de actitudes violentas en el entorno escolar, además de bajos índices de educación sobre temas relacionados con la violencia de género. La violencia física fue ejercida en mayor frecuencia en los niños y adolescentes varones, entre los 15 y 19 años, y en los municipios de Bahía Solano y El Carmen de Atrato. En contraste, la violencia sexual fue principalmente ejercida a las niñas, entre los 9 y 11 años, y en los municipios de Uribía y Pivijay. Conclusiones: las normas de género y las expectativas sociales atribuidas a las personas en función de su sexo exponen a niñas, niños y adolescentes a violencias diferenciadas; a ello se suman la edad y el lugar en el que se habita.
Abstract Objective: The study explores children and adolescents'perceptions, attitudes and behaviors regarding violence in family and school settings. Methodology: A survey about sexuality, family life and the school setting was conducted in 2018 to 16,558 children and adolescents aged between 9 and 19 years, who were attending school and were residents of eight municipalities of the Caribbean and Pacific regions of Colombia. Results: High percentages of family violence and violent behavior in the school setting were found along with a low degree of knowledge about subjects related to gender-based violence. Young boys and male adolescents aged between 15 and 19 years from Bahía Solano and El Carmen de Atrato municipalities were exposed most frequently to physical violence while girls aged between 9 and 11 years from Uribía and Pivijay were exposed mostly to sexual violence. Conclusions: Gender norms and social expectations expose children and adolescents to different types of violence. Other contributing factors are age and place of residence.
Resumo Objetivo: Explorar percepções, atitudes e práticas de algumas crianças e adolescentes sobre a violência nos ambientes familiar e escolar. Metodologia: Em 2018, foi aplicada uma pesquisa sobre sexualidade, vida familiar e ambiente escolar em 16.558 meninas, meninos e adolescentes entre 9 e 19 anos, habitantes de oito municípios da Colômbia. Resultados: Foram encontrados altos percentuais de violência doméstica e atitudes violentas no ambiente escolar, além de baixos níveis de educação em questões relacionadas à violência de gênero. A violência física foi maior em meninos e adolescentes, entre 15 e 19 anos, e nos municípios de Bahía Solano e El Carmen de Atrato. Por outro lado, a violência sexual foi maior em meninas, entre 9 e 11 anos, e nos municípios de Uribía e Pivijay. Conclusões: as normas de gênero e as expectativas sociais atribuídas às pessoas com base no sexo, expõem meninas e meninos e adolescentes à violência diferenciada, agregando idade e local onde moram.
RESUMEN
Resumen Introducción: La educación integral para la sexualidad permite dotar a niñas/os y adolescentes de conocimientos basados en datos empíricos, habilidades, actitudes y valores que fortalecen sus procesos de empoderamiento para disfrutar del derecho a la salud, el bienestar y la dignidad humana; además, les permite comprender cómo proteger y velar por la garantía de sus derechos a lo largo de su vida. Objetivo: Describir los conocimientos, actitudes y prácticas en educación sexual integral de 6 645 niñas y niños escolarizados en ocho municipios priorizados de Colombia. Metodología: Ocho municipios fueron seleccionados según indicadores socio-demográficos, embarazo adolescente y violencia de género. Los criterios de inclusión fueron definidos: niñas/os escolarizados de entre nueve y 11 años de edad y con residencia habitual en el municipio. Una encuesta de Conocimientos, Actitudes y Prácticas fue diseñada, validada y aplicada para recolectar datos de 5 600 hogares, 50 instituciones educativas y 6 645 niñas/ os. Se realizó un análisis descriptivo de la muestra, profundizando en los datos obtenidos del cuestionario aplicado a niñas/os. Resultados: Se encontraron altos porcentajes de desacuerdo de violencia directa contra la mujer y validación de formas sutiles de violencia en las niñas/os. Los niños reciben más castigos físicos que las niñas. El término sexualidad es desconocido por la mayoría de niñas y niños, quienes creen conocerlo lo dialogan principalmente con su mamá y más del 20 % no lo hablan con nadie. Las niñas y niños participantes están iniciando relaciones sexuales a edades tempranas sin previa educación en sexualidad. Conclusiones: Las niñas y niños interiorizan y reafirman roles tradicionales de género y tienen percepciones erradas sobre la sexualidad, por lo cual, es necesario profundizar en el significado de sexualidad y sobre la violencia basada en género. Esto con el fin de desarrollar capacidades en la toma de decisiones, que influyan positivamente en sus proyectos de vida.
Abstract Introduction: Comprehensive sexuality education enables children and adolescents to be provided with knowledge based on empirical data, skills, attitudes, and values that strengthen their empowerment processes to enjoy their right to health, well-being, and human dignity. Additionally, it allows them to understand how to protect and guarantee their rights throughout their lives. Objective: To describe the knowledge, attitudes, and practices in comprehensive sexuality education of 6,645 school age children enrolled in eight prioritized municipalities in Colombia. Methods: Eight municipalities were selected according to its sociodemographic characteristics, and indicators of teenage pregnancy and gender-based violence. The inclusion criteria were: children going to school between nine and eleven years old and habitually residing in the municipality. A Knowledge, Attitudes and Practices survey was designed, validated and applied to 5,600 families, 50 schools and 6,645 children. A descriptive analysis of the sample obtained was carried out, delving into the data obtained from the children's survey. Results: High percentages of disagreement regarding direct violence against women were found in children's responses, as well as validation of subtle forms of violence. Boys received more physical punishment than girls. The term sexuality is unknown by the majority of surveyed boys and girls, those who believe to understand it have discussed it mainly with their mothers and more than 20% have not spoken about it with anyone. The participating boys and girls are initiating sexual relations at an early age without prior sexuality education. Conclusions: Girls and boys internalize and reaffirm traditional gender roles and have wrong perceptions about sexuality. That is why, to develop with them decision-making skills that will have positively influence in their life projects it is necessary to deepen the meaning of sexuality and gender-based violence.
Asunto(s)
Humanos , Masculino , Femenino , Niño , Instituciones Académicas , Educación Sexual , Sexualidad , Vivienda , ColombiaRESUMEN
Resumen Objetivo: Caracterizar sociodemográficamente a los hombres que se practican vasectomías en Colombia, para generar evidencia que oriente la adaptación de los servicios de salud, con un enfoque de equidad de género, a las necesidades de los hombres. Metodología: Estudio descriptivo a partir de la "Encuesta Nacional de Demografía y Salud" de 2015, y del registro de los usuarios que accedieron al servicio de vasectomía en la Asociación Probienestar de la Familia Colombiana (Profamilia) durante los años 2015 y 2016. Las variables utilizadas fueron: edad, nivel de escolaridad, lugar de residencia, pertenencia étnica, estrato de residencia, estado civil, número de hijos nacidos vivos y variables relacionadas con roles de género. Resultados: El porcentaje de hombres que acceden a la vasectomía ha aumentado, aunque no con la intensidad esperada. En términos generales, el perfil del hombre que decide realizarse la vasectomía en Colombia es un joven entre 30 y 40 años, de los estratos 2 y 3, residente en zonas urbanas, al menos con un nivel educativo de básica secundaria, casado y con hijos, y contribuyente al sistema de salud. Se observó la persistencia de barreras de tipo social y cultural que afectan el uso de este método anticonceptivo. Conclusiones: Este estudio permitió una aproximación al perfil del hombre colombiano que se realiza la vasectomía. Recomendaciones: Ampliar la vasectomía como opción disponible y de fácil acceso para los hombres; eliminar estereotipos de género, y promover que hombres y mujeres compartan responsabilidades anticonceptivas; implementar modelos de atención en salud sexual y reproductiva más inclusivos y centrados también en las necesidades de los hombres.
Abstract Objective: To demographically characterize men who undergo vasectomies in Colombia, in order to generate evidence to guide the adaptation of health services with a focus on gender equity to the needs of men. Methodology: Descriptive study based on the Colombian Demography and Health survey (2015) and the registry of users who accessed the vasectomy service in Profamilia during 2015 and 2016. The variables used were age, level of education, place of residence, ethnicity, residence stratum, marital status, number of children born alive and variables related to gender roles. Results: The percentage of men who have access to vasectomy has increased, although not with the expected intensity. In general terms, the profile of the man who decides to have a vasectomy in Colombia is between 30 and 40 years old in strata 2 and 3, resident in urban areas, at least with a secondary education level, married and with children, and also a contributor to the health system. The persistence of social and cultural barriers that affect the widespread and sustained use of this contraceptive method were observed. Conclusions: This study allowed identify the profile of the Colombian man who undergoes vasectomy. Recommendations: To extend vasectomy as an option of easily available and accessible method for men; to eliminate gender stereotypes and promote shared contraceptive responsibilities for men and women; as well as the implementation of models of sexual and reproductive health care, which become more inclusive and also focused on the needs of men.
Resumo Objetivo: Caracterizar sociodemograficamente aos homens que se submetem a vasectomias na Colômbia, para gerar evidências que orientem a adaptação dos serviços de saúde com foco na equidade de gênero às necessidades dos homens. Metodologia: Estudo descritivo da Pesquisa Nacional sobre demografía e saúde (ends, 2015) e registro de usuários que acessaram o serviço de vasectomia em Profamilia durante os anos de 2015 y2016. As variáveis utilizadas foram idade, nível de escolaridade, local de residência, etnia, estrato de residência, estado civil, número de filhos nascidos vivos e variáveis relacionadas aos papéis de gênero. Resultados: A porcentagem de homens que têm acesso à vasectomia aumentou, embora não com a intensidade esperada. Em geral, o perfil do homem que decide realizar uma vasectomia na Colômbia é jovem entre 30 e 40 anos de estratos 2 e 3, que vivem em áreas urbanas, pelo menos um nível educacional médio, casados e com filhos e contribuintes ao sistema de saúde. A persistência das barreiras sociais e culturais que afetam o uso desse método contraceptivo foi observada. Conclusões: Este estudo permitiu identificar o perfil do homem colombiano submetido a uma vasectomia. Recomendações: Expandir a vasectomia como uma opção disponível e de fácil acesso para homens; eliminar estereótipos de gênero e promover que homens e mulheres compartilhem responsabilidades contraceptivas; implementar modelos de atenção em saúde sexual e reprodutiva mais inclusivos e também focados nas necessidades dos homens.