RESUMO
Urbanization is high and growing in low- and middle-income countries, but intraurban variations in adult health have been infrequently examined. We used spatial analysis methods to investigate spatial variation in total, cardiovascular disease, respiratory disease, and neoplasm adult mortality in Buenos Aires, Argentina, a large city within a middle-income country in Latin America. Conditional autoregressive models were used to examine the contribution of socioeconomic inequalities to the spatial patterning observed. Spatial autocorrelation was present in both men and women for total deaths, cardiovascular deaths, and other causes of death (Moran's Is ranging from 0.15 to 0.37). There was some spatial autocorrelation for respiratory deaths, which was stronger in men than in women. Neoplasm deaths were not spatially patterned. Socioeconomic disadvantage explained some of this spatial patterning and was strongly associated with death from all causes except respiratory deaths in women and neoplasms in men and women [relative rates (RR) for 90th vs 10th percentile of percent of adults with incomplete high school and 95% confidence intervals: 1.23 and 1.09-1.39 vs 1.24 and 1.08-1.42 for total deaths in men and women, respectively; 1.36 and 1.15-1.60 vs 1.22 and 1.01-1.47 for cardiovascular deaths; 1.21 and 0.97-1.52 vs 1.07 and 0.85-1.34 for respiratory deaths; 0.94 and 0.85-1.04 vs 1.03 and 0.87-1.22 for neoplasms; and 1.49 and 1.20-1.85 vs 1.63 and 1.31-2.03 for other deaths]. There is substantial intraurban variation in risk of death within cities. This spatial variability was present for multiple causes of death and is partly explained by the spatial patterning of socioeconomic disadvantage. Our results highlight the pervasive role of space and social inequalities in shaping life and death within large cities.
Assuntos
Mortalidade/tendências , Saúde da População Urbana/estatística & dados numéricos , Populações Vulneráveis/estatística & dados numéricos , Adulto , Distribuição por Idade , Idoso , Idoso de 80 Anos ou mais , Argentina/epidemiologia , Doenças Cardiovasculares/economia , Doenças Cardiovasculares/mortalidade , Análise por Conglomerados , Demografia , Feminino , Nível de Saúde , Humanos , Masculino , Pessoa de Meia-Idade , Neoplasias/economia , Neoplasias/mortalidade , Distribuição de Poisson , Doenças Respiratórias/economia , Doenças Respiratórias/mortalidade , Fatores Socioeconômicos , Urbanização/tendênciasRESUMO
In rural, developing world communities, women are often isolated from biomedical services. Frequently, traditional birth attendants (TBAs) are the only caregivers during childbirth, both normal and complicated. Women trust their TBAs to manage their births. Globally, government and non-governmental organizations (NGOs) have sought to upgrade TBAs' skills and to encourage them to refer complications. However, most training programs have failed to change TBAs' practice substantially. Logistical barriers in reaching biomedical services in a timely manner are a key issue. Another is the difference between biomedical and traditional practitioners in the cognitive frameworks that shape decision making and management behaviors. The purpose of this study, conducted in Quintana Roo State, Mexico, was to listen to the voices of practicing Yucatec Maya TBAs (parteras) as they described decision making and management of complicated births. In-depth interviews with six practicing parteras in rural, isolated communities revealed that the parteras used traditional Maya ethnomedicine while valuing biomedical approaches. We isolated themes in decision making and mapped management of birth complications. Integrating TBAs' traditional knowledge into biomedical training programs is one way to honor their knowledge and make training relevant.