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      Interrupción de servicios de salud para embarazadas, recién nacidos, niños y niñas, adolescentes y mujeres durante la pandemia de COVID-19: proyecto ISLAC 2020 Translated title: Disruption of health services for pregnant women, newborns, children, adolescents, and women during the COVID-19 pandemic: ISLAC 2020 Project Translated title: Interrupção dos serviços de saúde para grávidas, recém-nascidos, crianças, adolescentes e mulheres durante a pandemia de COVID-19: projeto ISLAC 2020

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          RESUMEN

          Objetivos.

          Describir la percepción de actores clave sobre la interrupción de los servicios de salud para poblaciones no priorizadas por la pandemia —embarazadas, recién nacidos, niños y niñas, adolescentes y mujeres— en países de América Latina y el Caribe (ALC) durante la primera etapa de la pandemia de COVID-19.

          Métodos.

          Estudio transversal. Se aplicó una encuesta a actores relevantes de 19 países de ALC entre julio y septiembre del 2020, con 35 preguntas sobre su percepción personal del estado de los servicios sociales y de salud en su país antes y durante la pandemia, así como una proyección para después de ella.

          Resultados.

          En las 691 respuestas, predominó la percepción de que la cobertura de servicios analizados era alta antes de la pandemia, aunque su calidad se apreció menor. Se percibió una reducción de la cobertura y la calidad de los servicios a adolescentes y mujeres. La mayoría estimó que todos los servicios seguirían con una menor cobertura tanto a los 3 como a los 12 meses (53,1% y 41,3%, respectivamente). Garantizar la cobertura y el acceso a los servicios de salud es el principal desafío político con vista al futuro, seguido del financiamiento de iniciativas para mujeres, niños, niñas y adolescentes, y la protección y promoción contra la violencia.

          Conclusiones.

          Aunque la pandemia ha golpeado a todos los países, la afectación en la provisión de servicios para las poblaciones analizadas es heterogénea entre países y tipos de servicio. Se requiere invertir en sistemas de información nacionales que permitan monitorear los distintos servicios e identificar las poblaciones que no se han priorizado.

          ABSTRACT

          Objective.

          Describe the perceptions of key actors regarding the disruption of health services for populations that ceased to be prioritized because of the COVID-19 pandemic—pregnant women, newborn, children, adolescents, and women—in countries of Latin America and the Caribbean (LAC) during the first stage of the pandemic.

          Methods.

          In this cross-sectional study, a 35-question survey was administered to key actors in 19 LAC countries between July and September 2020. The respondents were asked for their personal perceptions regarding the situation of social and health services in their country before and during the pandemic. They were also asked for a projection of the situation during the post-pandemic period.

          Results.

          In the 691 responses received, the main perception was that coverage in the services analyzed had been high before the pandemic, although their quality was not as highly rated. Both the coverage and quality of services were thought to have declined for adolescents and women. The majority of respondents predicted that all services will continue to function at lower than usual coverage levels for another three months (53.1%) and another 12 months (41.3%). Guaranteeing coverage and access to health services was considered the main policy challenge going forward. The next most needed initiatives noted were financing for actions to support women, children, and adolescents, and protection against violence and promotion of measures to combat it.

          Conclusions.

          Although the pandemic has struck all countries, its effect on the delivery of services in the populations analyzed differs from country to country and according to the types of service. It is essential to invest in national information systems that will make it possible to monitor the different services and identify the populations that need to be prioritized.

          RESUMO

          Objetivos.

          Descrever a percepção de atores-chave na interrupção dos serviços de saúde para populações não priorizadas na pandemia — grávidas, recém-nascidos, crianças, adolescentes e mulheres — em países da América Latina e do Caribe (ALC) durante a primeira fase da pandemia de COVID-19.

          Métodos.

          Estudo transversal. Foi realizada uma pesquisa com atores relevantes de 19 países da ALC entre julho e setembro de 2020, com 35 perguntas sobre a percepção pessoal do estado dos serviços sociais e de saúde em seus países antes e durante a pandemia, bem como uma projeção para depois dela.

          Resultados.

          Nas 691 respostas, predominou a percepção de que a cobertura dos serviços analisados era alta antes da pandemia, embora a qualidade fosse vista como mais baixa. Notou-se uma redução na cobertura e na qualidade dos serviços a adolescentes e mulheres. A maioria estimou que todos os serviços seguiriam com uma menor cobertura tanto em 3 como em 12 meses (53,1% e 41,3%, respectivamente). Garantir a cobertura e o acesso aos serviços de saúde é o principal desafio político para o futuro, seguido do financiamento de iniciativas para mulheres, crianças e adolescentes, e da proteção e promoção contra a violência.

          Conclusões.

          Embora a pandemia tenha afetado todos os países, o abalo na provisão de serviços para as populações analisadas é heterogêneo entre os países e os tipos de serviço. É preciso investir em sistemas de informação nacionais que permitam monitorar os distintos serviços e identificar as populações que não foram priorizadas.

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          Most cited references27

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          Early estimates of the indirect effects of the COVID-19 pandemic on maternal and child mortality in low-income and middle-income countries: a modelling study

          Summary Background While the COVID-19 pandemic will increase mortality due to the virus, it is also likely to increase mortality indirectly. In this study, we estimate the additional maternal and under-5 child deaths resulting from the potential disruption of health systems and decreased access to food. Methods We modelled three scenarios in which the coverage of essential maternal and child health interventions is reduced by 9·8–51·9% and the prevalence of wasting is increased by 10–50%. Although our scenarios are hypothetical, we sought to reflect real-world possibilities, given emerging reports of the supply-side and demand-side effects of the pandemic. We used the Lives Saved Tool to estimate the additional maternal and under-5 child deaths under each scenario, in 118 low-income and middle-income countries. We estimated additional deaths for a single month and extrapolated for 3 months, 6 months, and 12 months. Findings Our least severe scenario (coverage reductions of 9·8–18·5% and wasting increase of 10%) over 6 months would result in 253 500 additional child deaths and 12 200 additional maternal deaths. Our most severe scenario (coverage reductions of 39·3–51·9% and wasting increase of 50%) over 6 months would result in 1 157 000 additional child deaths and 56 700 additional maternal deaths. These additional deaths would represent an increase of 9·8–44·7% in under-5 child deaths per month, and an 8·3–38·6% increase in maternal deaths per month, across the 118 countries. Across our three scenarios, the reduced coverage of four childbirth interventions (parenteral administration of uterotonics, antibiotics, and anticonvulsants, and clean birth environments) would account for approximately 60% of additional maternal deaths. The increase in wasting prevalence would account for 18–23% of additional child deaths and reduced coverage of antibiotics for pneumonia and neonatal sepsis and of oral rehydration solution for diarrhoea would together account for around 41% of additional child deaths. Interpretation Our estimates are based on tentative assumptions and represent a wide range of outcomes. Nonetheless, they show that, if routine health care is disrupted and access to food is decreased (as a result of unavoidable shocks, health system collapse, or intentional choices made in responding to the pandemic), the increase in child and maternal deaths will be devastating. We hope these numbers add context as policy makers establish guidelines and allocate resources in the days and months to come. Funding Bill & Melinda Gates Foundation, Global Affairs Canada.
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            Children and young people remain at low risk of COVID-19 mortality

            Since early reports from China stated that severe COVID-19 disease was rare in children, 1 we have analysed child COVID-19 mortality in seven countries. To put the deaths into a context that would help the understanding of parents, clinicians, and policy makers, we previously made comparisons of COVID-19 deaths with modelled mortality from all causes and other causes. Our first publication in April, 2020, 2 was followed by a trend analysis up to August, 2020. 3 We also update a data table online. Here, we update this analysis to February, 2021, in light of increases in adult mortality through the 2020–21 winter, and concerns about variant B.1.1.7, first identified in the UK in December, 2020 (probably circulating since September). 4 Table Age-specific data for seven countries showing estimated all-cause deaths compared with COVID-19 deaths Population All-cause deaths * COVID-19 deaths † COVID-19 deaths as percentage of all-cause deaths, % n per 100 000 n per 100 000 USA 0–4 years 19 810 275 23 844 120·36 67 0·34 0·28% 5–14 years 41 075 169 4990 12·15 67 0·16 1·34% UK 0–9 years 8 052 552 3793 47·10 7 0·09 0·19% 10–19 years 7 528 144 1109 14·73 22 0·29 1·98% Italy 0–9 years 5 090 482 1569 30·83 8 0·16 0·51% 10–19 years 5 768 874 772 13·38 10 0·17 1·30% Germany 0–9 years 7 588 635 2782 36·66 9 0·12 0·32% 10–19 years 7 705 657 1249 16·21 4 0·05 0·32% Spain 0–9 years 4 370 858 1369 31·31 28 0·64 2·05% 10–19 years 4 883 447 532 10·89 26 0·53 4·90% France 0–9 years 7 755 755 2916 37·60 7 0·09 0·24% 10–19 years 8 328 988 1068 12·82 4 0·05 0·38% South Korea 0–9 years 4 148 654 1519 36·61 0 0·00 0 10–19 years 4 940 455 814 16·48 0 0·00 0 Total 137 047 945 48 326 35·26 259 0·19 0·54% The sources of these data are provided in the appendix (p 2). * Includes all deaths from approximately March 1, 2020, to Feb 1, 2021. † Includes all COVID-19 deaths reported from the start of the pandemic up to Feb 3, 2021 (USA), Jan 29, 2021 (UK), Jan 20, 2021 (Italy), Feb 9, 2021 (Germany), Feb 10, 2021 (Spain), Feb 11, 2021 (France), or Feb 3, 2021 (South Korea). In the USA, UK, Italy, Germany, Spain, France, and South Korea, deaths from COVID-19 in children remained rare up to February, 2021, at 0·19 per 100 000 population, comprising 0·54% of the estimated total mortality from all causes in a normal year (table, appendix p 2). Deaths from COVID-19 were relatively more frequent in older children compared with younger age groups. The differences between countries need careful interpretation because of small numbers, possible differences in case definition and death reporting mechanisms, and the related condition paediatric inflammatory multisystem syndrome temporally associated with COVID-19, which might not always be captured in these data. The highest rate of deaths per 100 000 children was in Spain (0·64 for children aged 0–9 years; 0·53 for children aged 10–19 years) and the lowest in South Korea (0 deaths for children aged 0–9 years and 10–19 years). Overall, there was no clear evidence of a trend of increasing mortality throughout the period up to February, 2021, but additional deaths have clearly occurred in children and young people during periods of high community transmission, particularly in Spain, Germany, and Italy (appendix p 3). Although COVID-19 mortality data are contemporary and likely to accurately represent the reality in these countries, it is not possible to access such data for other causes of death. We therefore used estimates from the Global Burden of Disease 2017 database, which does not account for seasonality or changes in mortality patterns in this pandemic year. Nevertheless, the very low mortality we describe from COVID-19 compared with all-causes is likely to be of the correct magnitude. With the caveat that some children at high risk might be using extreme so-called shielding measures, children are overall not becoming seriously unwell with COVID-19, 5 and data from England show that children are also not requiring intensive care in large numbers. 6 Some of the measures to counteract the devastating impact of the virus on adults are having unintended negative consequences for children. 7 The possible benefit to wider society of these measures should be constantly scrutinised to ensure proportionality in line with outcomes for all. Our evidence indicates that children continue to be mostly, but not completely, spared the worst outcome of the pandemic, particularly compared with older adults who have been much harder hit. 8 We continue to caution that the virus is likely to change over time, and that these conclusions should be kept under review.
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              WHO Coronavirus (COVID‐19) dashboard

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                Author and article information

                Journal
                Rev Panam Salud Publica
                Rev Panam Salud Publica
                rpsp
                Revista Panamericana de Salud Pública
                Organización Panamericana de la Salud
                1020-4989
                1680-5348
                03 November 2021
                2021
                : 45
                : e140
                Affiliations
                [1 ] orgnameUniversidad de Santiago de Chile Santiago Chile originalUniversidad de Santiago de Chile, Santiago, Chile.
                [2 ] normalizedEscuela de Salud Pública y Medicina Tropical orgnameUniversidad de Tulane Nueva Orleans Estados Unidos de América originalEscuela de Salud Pública y Medicina Tropical, Universidad de Tulane, Nueva Orleans, Estados Unidos de América
                Author notes
                Article
                RPSP.2021.140
                10.26633/RPSP.2021.140
                8559667
                34737772
                37d9760e-00a1-498e-94c1-7a966a2c9581

                Este es un artículo de acceso abierto distribuido bajo los términos de la licencia Creative Commons Attribution-NonCommercial-NoDerivs 3.0 IGO, que permite su uso, distribución y reproducción en cualquier medio, siempre que el trabajo original se cite de la manera adecuada. No se permiten modificaciones a los artículos ni su uso comercial. Al reproducir un artículo no debe haber ningún indicio de que la OPS o el artículo avalan a una organización o un producto específico. El uso del logo de la OPS no está permitido. Esta leyenda debe conservarse, junto con la URL original del artículo. Crédito del logo y texto open access: PLoS, bajo licencia Creative Commons Attribution-Share Alike 3.0 Unported.

                History
                : 29 April 2021
                : 13 August 2021
                Page count
                Figures: 3, Tables: 3, Equations: 1, References: 27
                Funding
                Award ID:  
                Financiación. El estudio recibió la subvención LAT-2020-096-S4I de la Fundación Bernard van Leer con financiamiento para la Universidad de Tulane, Nueva Orleans, Estados Unidos, y la Universidad Santiago de Chile, Santiago, Chile.
                Categories
                Investigación Original

                servicios de salud,infecciones por coronavirus,niños,adolescentes,mujeres,mujeres embarazadas,américa latina,región del caribe,health services,coronavirus infections,child,adolescent,women,pregnant women,latin america,caribbean region,serviços de saúde,infecções por coronavirus,criança,adolescente,mulheres,gestantes,região do caribe

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