RESUMO
Socioeconomic status is generally associated with better health, but recent evidence suggests that this 'social gradient' in health is far from universal. This study examines whether social gradients in smoking and obesity in Mexico - a country in the midst of rapid socioeconomic change - conform to or diverge from results for richer countries. Using a nationally representative sample of 39,129 Mexican adults, we calculate the odds of smoking and of being obese by educational attainment and by household wealth. We conclude that socioeconomic determinants of smoking and obesity in Mexico are complex, with some flat gradients and some strong positive or negative gradients. Higher social status (education and assets) is associated with more smoking and less obesity for urban women. Higher status rural women also smoke more, but obesity for these women has a non-linear relationship to education. For urban men, higher asset levels (but not education) are associated with obesity, whereas education is protective of smoking. Higher status rural men with more assets are more likely to smoke and be obese. As household wealth, education and urbanisation continue to increase in Mexico, these patterns suggest potential targets for public health intervention now and in the future.
Assuntos
Comportamentos Relacionados com a Saúde , Obesidade/epidemiologia , Fumar/epidemiologia , Adulto , Fatores Etários , Idoso , Escolaridade , Feminino , Inquéritos Epidemiológicos , Humanos , Modelos Logísticos , Masculino , México/epidemiologia , Pessoa de Meia-Idade , Obesidade/economia , Prevalência , Fatores de Risco , Saúde da População Rural , Fatores Sexuais , Fumar/economia , Classe Social , Saúde da População Urbana , Adulto JovemRESUMO
In this paper, we explore the diffusion of beliefs pertaining to the causes of childhood diarrhea in rural Guatemala. The analysis focuses on the importance of interpersonal and impersonal contacts as conduits for information and norms related to hygiene and contamination. Estimates from multivariate models reveal that there is evidence of a diffusion process through social contacts, primarily through interpersonal ones. The analysis also identifies striking differences between (1) the diffusion process related to hygiene (e.g. dirtiness) and that related to contamination (e.g. pathogens); and (2) beliefs about the causes of diarrheal illness among children in general and those among respondents' own children.
Assuntos
Atitude Frente a Saúde , Diarreia/etiologia , Higiene , Infecções , Serviços de Informação/estatística & dados numéricos , Relações Interpessoais , Adolescente , Adulto , Criança , Pré-Escolar , Diarreia/mortalidade , Transmissão de Doença Infecciosa , Feminino , Guatemala/epidemiologia , Humanos , Pobreza , População RuralRESUMO
BACKGROUND: During the past two decades, health interview surveys have become an increasingly common source of information about current morbidity patterns and utilization of health services in developing countries. This study describes a recent effort to enhance the utility of these surveys by incorporating a calendar format. METHODS: A calendar of morbidity and treatment behaviour during the 2-week period prior to interview was implemented in the Guatemalan Survey of Family Health (EGSF), a large-scale sample survey that was fielded in 60 communities in rural Guatemala in 1995. A total of 2872 women aged 18-35 were interviewed and provided information on 3193 children born since 1990. RESULTS: The EGSF calendar data provide estimates of diarrhoeal illness that are consistent with those obtained from more conventional questionnaire designs. However, in contrast to conventional health survey questions, these calendar data: (1) permit a much more complete evaluation of the accuracy of reporting; and (2) offer a richer and more complex description of child illness and treatment behaviour. For example, the results demonstrate that even the preferred 2-week recall period suffers from underreporting of diarrhoeal illness, that the majority of children with diarrhoea experience at least one additional symptom, and that mothers assess severity of diarrhoea from the type and number of accompanying symptoms. CONCLUSIONS: The findings indicate that additional implementation and evaluation of calendar formats is warranted in order to provide the most useful and accurate data possible at relatively low cost.
Assuntos
Países em Desenvolvimento , Serviços de Saúde/estatística & dados numéricos , Inquéritos Epidemiológicos , Morbidade , Adolescente , Adulto , Pré-Escolar , Diarreia Infantil/epidemiologia , Feminino , Guatemala , Humanos , Lactente , Recém-Nascido , Masculino , Prontuários MédicosRESUMO
In this paper we investigate family choices about pregnancy-related care and the use of childhood immunization. Estimates obtained from a multilevel logistic model indicate that use of formal (or "modern") health services differs substantially by ethnicity, by social and economic factors, and by availability of health services. The results also show that family and community membership are very important determinants of the use of health care, even in the presence of controls for a large number of observed characteristics of individuals, families, and communities.
Assuntos
Parto Obstétrico/estatística & dados numéricos , Saúde da Família/etnologia , Imunização/estatística & dados numéricos , Aceitação pelo Paciente de Cuidados de Saúde , Cuidado Pré-Natal/estatística & dados numéricos , Pré-Escolar , Características da Família/etnologia , Feminino , Guatemala/etnologia , Acessibilidade aos Serviços de Saúde , Inquéritos Epidemiológicos , Humanos , Indígenas Centro-Americanos/estatística & dados numéricos , Lactente , Recém-Nascido , Medicina Tradicional , Tocologia/estatística & dados numéricos , Aceitação pelo Paciente de Cuidados de Saúde/etnologia , Aceitação pelo Paciente de Cuidados de Saúde/estatística & dados numéricos , Gravidez , População Rural/estatística & dados numéricos , Estudos de Amostragem , Fatores Socioeconômicos , Televisão/estatística & dados numéricos , População Urbana/estatística & dados numéricosRESUMO
This paper is an investigation of the effects of social inequality in Guatemala on children's health and nutritional status as measured by attained height. Guatemala remains a highly stratified and poor society. We examine the association of land distribution, land tenure, occupation, and other aspects of family social and economic status with children's height between the ages of three months and 36 months, using data from a cross-sectional survey. An important consequence of the poverty and poor living conditions of the majority of the Guatemalan population is substantial deficits in children's growth. Our results suggest that children's growth is affected by ethnicity, their father's occupation, land distribution in the area where they live, and maternal education. Substantial growth deficits are observed among children living at altitudes above 1500 metres; we hypothesize that this is because, in Guatemala, higher altitude is associated with land scarcity, poorer agricultural conditions, and greater remoteness from transport networks and other public services.
PIP: Population researchers used data from the 1987 National Survey of Maternal and Child Health, 1981 census of population and housing, and the 1979 agricultural census to examine the relationship between land distribution, land tenure, occupation, and other characteristics of family socioeconomic status with children's growth between the ages of 3 months to 36 months in Guatemala. 57.8% of the children were stunted. 71.9% of the children lived in rural areas characterized as poor and in inferior living conditions. Characteristics influencing children's growth included ethnicity (indigenous children shorter than ladinos), father's occupation (agriculture or unskilled occupations had a negative effect on growth), land distribution (the smaller the farm, the greater the deficit in height), and maternal education. Children living at altitudes greater than 1500 meters were shorter than those living at elevations less than 1500 meters (p 0.05). Land scarcity, poorer agricultural conditions, and greater distance from transport networks and other public services were likely responsible for the association between altitude and growth. Indigenous populations were more likely to live at higher elevations than ladinos, partly because, over the last 200 years, ladinos appropriated the more productive, accessible, and desirable lands at moderate elevations. Father's occupation, land ownership, housing quality, possession of consumer goods, residency, and size of farms in area accounted for about 24% of the variation in height-for-age. These findings show that poverty and poor living conditions for most of the population adversely affect children's growth.
Assuntos
Crescimento , Pobreza , Adolescente , Adulto , Estatura , Peso Corporal , Pré-Escolar , Estudos Transversais , Feminino , Guatemala/epidemiologia , Guatemala/etnologia , Humanos , Lactente , Masculino , Análise Multivariada , Estado Nutricional , Fatores SocioeconômicosRESUMO
Immunization against major childhood diseases has been an essential component of health policies in developing countries. However, despite its importance and the efforts invested by many organizations in promoting immunization programs, consistent and accurate measurement of immunization coverage has not yet been achieved. In this paper, we explore the implications of alternative methods of measuring immunization coverage rates in Guatemala, using data from the 1987 Encuesta Nacional de Salud Materno Infantil, and we consider the dangers of making inferences about levels and trends in coverage from cross-sectional data. The results indicate that (1) service statistics may well lead to overestimates of coverage; (2) survey estimates derived from health cards can also produce severely biased estimates; and (3) in spite of problems associated with maternal recall, mothers' reports of their children's vaccination status probably result in substantially improved estimates of immunization coverage.
Assuntos
Países em Desenvolvimento , Pesquisa sobre Serviços de Saúde/métodos , Imunização/estatística & dados numéricos , Prontuários Médicos , Memória , Mães/psicologia , Viés , Pré-Escolar , Estudos Transversais , Coleta de Dados , Interpretação Estatística de Dados , Guatemala , Política de Saúde , Promoção da Saúde , Humanos , Imunização/tendências , Lactente , Recém-Nascido , Cooperação do Paciente , Reprodutibilidade dos TestesRESUMO
In this paper we examine the experience of one poor country, Guatemala, that provided childhood immunization partly through a major national campaign, and provided pregnancy-related services through government health facilities, during the 1980s. Specifically, we compare the breadth of coverage of these two types of services using national sample survey data collected in 1987. We then draw upon results of previous qualitative studies to explore the social, cultural, and organizational factors that may account for differences between the use of immunization and the use of pregnancy-related health services.
Assuntos
Serviços de Saúde da Criança/estatística & dados numéricos , Programas de Imunização/estatística & dados numéricos , Serviços de Saúde Materna/estatística & dados numéricos , Criança , Serviços de Saúde da Criança/provisão & distribuição , Coleta de Dados , Países em Desenvolvimento , Guatemala/etnologia , Necessidades e Demandas de Serviços de Saúde , Humanos , Programas de Imunização/provisão & distribuição , Serviços de Saúde Materna/provisão & distribuição , Análise Multivariada , Gravidez , Cuidado Pré-Natal , Avaliação de Programas e Projetos de Saúde , Fatores SocioeconômicosAssuntos
Mortalidade Infantil , Reprodução , Intervalo entre Nascimentos , Aleitamento Materno , Feminino , Guatemala , Humanos , Lactente , Recém-Nascido , Idade Materna , Paridade , Gravidez , Risco , Fatores SocioeconômicosRESUMO
PIP: Data examined in this study are from the 1976 Mexican Fertility Survey. The authors review previous findings and compare information from this survey with data from the 1969 PECFAL Survey. They then examine the types of consensual union and factors such as women's age, educational status, occupation, premarital fertility, and rural or urban residence. The focus of the study is on the extent to which consensual unions eventually become legal marriages. The authors also investigate the increasing probability of termination of marriage through divorce or separation, especially in urban areas.^ieng
Assuntos
Fatores Etários , Divórcio , Escolaridade , Fertilidade , Casamento , Ocupações , Características de Residência , População Rural , População Urbana , América , América Central , Demografia , Países Desenvolvidos , Países em Desenvolvimento , Economia , Geografia , Mão de Obra em Saúde , América Latina , México , América do Norte , População , Características da População , Dinâmica Populacional , Classe Social , Fatores SocioeconômicosAssuntos
Fertilidade , Legislação como Assunto , Casamento , Análise Atuarial , Adolescente , Adulto , Feminino , Humanos , México , Pessoa de Meia-IdadeRESUMO
Life table calculations from survey data are frequently based on events for which exact dates are not available. When these dates are coded in monthly form (e.g., century months), estimates should take into account the fact that the first duration interval--the interval which captures events occurring in the first month of exposure--is half the length of all remaining intervals. Although failure to do so has a trivial effect on many demographic calculations, estimates which are based on events which occur with high frequency in the first few months of exposure can be substantially biased. Estimates of fecundability for four countries in the World Fertility Survey are used to illustrate this bias.