|
Geographical Locations - Bolivia
 The WWW Virtual Library: Public Health
Categories
Country Information
- (Statistical) Number of Inhabitants per Doctor: 2,124
- CIA - World Factbook : Bolivia
Organisations and Networks
UN and Multinational
Government
Non-Government
Academic Institutions
National Policy and Related Documents
Reports, Guidelines, and Projects
- A holistic approach to diabetes care in Bolivia
Bolivia is a land-locked country in central South America. Bordered by five nations, it is one of the so-called developing countries; levels of infant mortality and illiteracy are among the highest in the world. While Bolivia is rich in ethnic and cultural diversity and natural resources, including silver and natural gas, the development of the nation continues to be constrained by economic and societal problems which affect all levels of society. Furthermore, the areas of health and education have been severely under-funded by successive governments. Elizabeth Duarte reports on the achievements of a centre for diabetes care and education in Cochabamba, Bolivia where local knowledge and expertise are married with resources and experience obtained through successful partnerships with national and international companies and organizations. [publication summary] [Diabetes Voice, March 2005 Volume 50 Issue 1, pp.38-40]
- Baseline Assessments of Essential Obstetric Care: Bolivia, Ecuador, and Honduras
In an attempt to address high maternal mortality and morbidity in Latin America and the Caribbean, the United States Agency for International Development (USAID) began the Latin America and Caribbean Regional Initiative to Reduce Maternal Mortality (LAMM) in 1996. Recognizing that existing USAID-supported programs already address family planning, prenatal care, and clean delivery strategies to reduce maternal mortality, LAMM targets essential obstetric care at the first level of referral facilities. Bolivia, Ecuador, and Honduras were sites for the development and pilot testing of essential obstetric care (EOC) interventions. Under LAMM, the Quality Assurance Project (QAP) is responsible for supporting process redesign and quality improvement teams as they address weak components in the EOC system. QAP conducted a baseline assessment of the quality of care and compliance with EOC standards at the facility level in a selected area of each country in 1998. The QAP LAMM team developed a set of 21 indicators to measure quality of care and how each system was functioning. Data on the indicators were collected through the review of patient medical records and other facility records, structured observation of deliveries, and a questionnaire completed by healthcare professionals. The assessments indicate that adequate infrastructure to provide EOC exists in all three study areas. However, deficits were documented in the capacity of these facilities to deliver quality EOC services. Inadequate supplies and equipment, lack of trained personnel, and failure to comply with quality standards all limit the functional access to EOC. The assessments also suggest that low utilization of the study facilities is an important barrier to the delivery of EOC in all three countries. [extract from publication summary] [Technical Report Summary 1(3), U.S. Agency for International Development (USAID) by the Quality Assurance Project (QAP), 2001]
- Bolivia’s Health Reform: a response to improve access to obstetric care
This chapter presents a historical overview of the development of a health insurance policy in Bolivia, describing its impact on improving obstetric care. It details the gradual extension of coverage, its legal framework, sources of finance, administrative system, service provision and finally monitoring and evaluation system, all of which gave rise to increased coverage of antenatal consultations and skilled attendant deliveries. It concludes with lessons learnt. The model for public health insurance in Bolivia has existed for the past 10 years. It was initiated as the “National Insurance Scheme for Maternity and Childhood” with service packages for 32 health issues, continued as the “Basic Health Insurance Scheme”, which expanded to 92 service packages, and since 2002 has been called the “Universal Mother and Child Insurance Scheme” (SUMI4), providing service packages for 547 health issues affecting pregnant women from the beginning of pregnancy until 6 months after childbirth and to children from birth to 5 years of age. SUMI has 3 main sources of financing: municipal, departmental and national. Through a credit agreement, the World Bank established the management and supervision system, including coverage indicators with quarterly monitoring and reports. The first years after the introduction of the insurance package, 1998 to 2003, saw the greatest coverage increase in antenatal care visits and skilled attendant deliveries; whilst in recent years this growth trend has reached a plateau. This has served to address somewhat the existing geographical and cultural barriers through innovative strategies such as mobile “brigades”, community pharmacies and an intercultural health component that reinforces the use of services in rural areas. Bolivia still requires further innovative approaches to improve maternal health, and universal coverage needs to be considered a political goal to achieve equity in the right to access quality services. [publication abstract] [Studies in HSO&P, 24, 2008, pp.199-222]
- Collaboration between private pharmacies and national tuberculosis programme: an intervention in Bolivia
Background: Public–private partnerships are felt to be necessary for tuberculosis (TB) control in some developing countries. Objectives: To evaluate the potential of a collaboration between the National TB Programme (NTP) and private pharmacies in Bolivia, the country with the highest TB incidence in Latin America. Methods: We contacted the local Pharmacists’ Association in the city of Cochabamba, and designed a two phase intervention. The objectives of the first phase were to decrease the availability of TB drugs in private pharmacies on a voluntary basis, and to improve referral of clients seeking TB drugs to the NTP. A survey of all pharmacies allowed for a before–after comparison with a baseline survey. The objectives of the second phase were to obtain referral of pharmacy clients with chronic cough for TB screening in the NTP. This phase was started in 70 pharmacies and evaluated after 2 months using the referral slips issued by the pharmacists. Results: The proportion of pharmacies selling TB drugs decreased (rifampicin: 23–11.5%; isoniazid: 16–3.1%; P < 0.001) and the proportion of pharmacies referring to the NTP clients seeking TB drugs increased (22–58%; P < 0.0001). In the second phase, 26 of 70 pharmacies (38%) referred a total of 41 clients for screening in the NTP (i.e. an average of 0.29 clients per pharmacy and per month); 11 of 41 (27%) were screened and three of 11 (27%) diagnosed with smear-positive TB. Conclusion: The first phase of the intervention proved effective in reducing the availability of the main TB drugs in pharmacies, and in improving referral of clients seeking TB drugs. Key factors in this success were not specific to Bolivia, and collaboration between private pharmacies and public services appears possible in that respect. However, collaboration with pharmacies does not seem an efficient way to increase the number of patients screened for TB, and to shorten delays to TB diagnosis and treatment. [author abstract] [Tropical Medicine and International Health, vol. 10, no. 3, pp 246–250, March 2005]
- Cross-cultural Adaptation of Reproductive Health Services in Bolivia
"Bolivia’s indigenous peoples, who make up nearly 60 percent of the country’s population, face cultural barriers in access to and use of health services. The Bolivian Ministry of Health and Sports (MOH) and the Integral Health Project (Proyecto de Salud Integral, PROSIN), with the technical assistance of the Population Council’s Frontiers in Reproductive Health Program (FRONTIERS), tested several strategies to make health services in Bolivia more culturally appropriate. This operations research project was developed in the municipality of Tinguipaya, in the department of Potosí. Tinguipaya is largely rural and has the lowest socio-economic and health indicators in the country. The majority (62%) of the inhabitants of the municipality speaks only Quechua and maintain ancestral customs from the Inca period, including the communal ownership of land, social and economic organization, and techniques for farming. The municipality has 10 health facilities – one health center in the village of Tinguipaya (where 3% of the population lives), and nine health posts. The goal of this project was to increase women’s access to, use of, and satisfaction with health services in general, and reproductive health services in particular, by offering culturally appropriate health services. The project worked with health providers to: a) enhance the understanding and acceptance of the “other” culture; b) improve their communication skills; c) facilitate and promote their use of the Quechua language in clinics; d) systematically screen their clients’ health service needs; and e) establish self-assessment and supervision mechanisms. The project also sought to promote community-provider interactions by creating advisory committees for women to voice expectations of health care services, and by fostering interaction between traditional health providers and the modern system." [Population Council, Frontiers in Reproductive Health Program, September 2005]
- Demonstrating Public Health at Work: A Demonstration Project of Congenital Syphilis Prevention Efforts in Bolivia
Objectives: We introduced syphilis immunochromatic strip (ICS) tests into antenatal care (ANC) settings in Bolivia and evaluated feasibility, patient and provider acceptability, and introduction costs. We conducted complementary studies on related topics, strengthened quality of care, and aided the response to sensitive aspects of maternal/congenital syphilis control (e.g., partner notification). Goal: The goal of this study was to discuss our experience working with Bolivian stakeholders to document potential public health benefits of syphilis ICS test introduction in ANC settings. Study Design: We trained public health personnel and offered the Abbott Determine Rapid Syphilis TP test in 4 urban maternity hospitals and 37 rural clinics. Results: Using the ICS test, 11,618 women were tested for syphilis; 5% had positive results and 93.2% received treatment. Women and health personnel found the test acceptable and introduction costs were not prohibitive. Conclusions: Based on these findings, by mid-2006, the Bolivian Ministry of Health will offer the ICS tests in rural ANC settings. [author abstract] [Sexually Transmitted Diseases, July Supplement 2007, Vol. 34, No. 7, p.S37–S41]
- Diabetes in Bolivia
Objective: To measure the prevalence of diabetes mellitus (DM), hypertension, obesity, and related risk factors in major cities in Bolivia Methods: A population-based survey was conducted in four Bolivian cities: La Paz, El Alto, Santa Cruz, and Cochabamba. The total sample size was chosen to be 2 948 persons. The overall response rate was 86%, with the rate varying somewhat among the four cities. DM was diagnosed through an oral glucose tolerance test (OGTT) 2 hours after an overload of 75 grams of glucose, using World Health Organization criteria. Results: The overall prevalence of DM in the four urban areas combined was 7.2% (95% confidence interval (CI): 6.2%–8.3%) and of impaired glucose tolerance (IGT) was 7.8%. A total of 73.1% (95% CI: 65.0%–81.0% ) of those previously diagnosed with DM and 73.7% (95% CI: 61.0%–86.4%) of newly diagnosed cases were overweight, according to measurements of body mass index. Hypertension was found in 36.5% (95% CI: 27.6%–45.5%) of known diabetics and in 36.6% (95% CI: 23.0%–50.1%) of newly diagnosed cases, compared to only 15.9% (95% CI: 14.3%–17.5%) among people without DM. The disease was most common among older persons and those with little education. Conclusions: Diabetes is a genuine public health problem in Bolivia. Further, the high prevalence of IGT that was found suggests that diabetes prevalence will increase in the near future in the country unless prevention strategies are implemented. [author abstract] [Rev Panam Salud Publica/Pan Am J Public Health 10(5), 2001, pp.318-323]
- Health in the Americas 2007: Bolivia
As a health agency, the Pan American Health Organization’s core discipline is epidemiology, which enables the measurement, definition, and comparison of health problems and conditions and their distribution from the perspectives of population, geography, and time. This publication on Bolivia addresses the issue of health as a human right, taking into account both the individual and community contexts, and examines various critical determinants of health, including those of a biological, social, cultural, economic, and political nature. That examination reveals the existence of gaps, disparities, and inequities that persist in Bolivia, especially those related to access to basic services, health, nutrition, housing, and adequate living conditions as well as to the lack of opportunities for human development—all of which contribute to the greater vulnerability to diseases and health risks of some population groups. [Adapted from the preface of Health in the Americas 2007]
- Health Worker Salaries and Benefits: Lessons from Bolivia, Peru and Chile: Final Report
"Bolivia, Peru and Chile are: i) shortage of health workers, disparity of skills (many specialized physicians, few general physicians or public heath specialists), ii) poor distribution of health workers, iii) inadequate working environments, including technological deficiencies; and, iv) low knowledge about the characteristic of HWSB, which impedes planning. The data collected about Bolivia, Peru and Chile shows that in general, the wages of doctors during the last fifteen years have had to increase more than the wages of other works (a similar phenomenon occurring with education workers). Health workers salaries respond to many different criteria. The basic salary represents between half and two-thirds of the total income. The rest is made up of time-on-the-job bonuses, bonuses for working in remote areas, adjustments for advanced studies and other special designations. Several political and economic variables play in the determination of salary levels. Amongst the political factors are the bargaining power of unions and other groups (professional bodies, for example). In the economic arena, economic growth and inflation are important factors. Regarding policies oriented to recruit and retain health worker, the public sector continues to be, in these countries, the largest employer and in general has no major problems finding employees, with the exception of specific specialties which arise from time to time. Retention, however, is growingly difficult due to the fact that the private sector offers better working conditions. In face of this, the public sector in these countries has chosen to allow health workers to make their services available both to the public and private sectors." [WHO, April 2008]
- Human Papillomavirus Infection among Bolivian Amazonian Women
Cervical cancer is the most common malignancy among women in Latin America. Human papilloma virus infection is known to be an important risk factor. However, HPV infection among Bolivian women has not yet been fully evaluated. The present study aimed to investigate HPV infection among women living in a rural region of the Bolivian Amazon. Cervical swab samples were collected from 151 healthy women in three Amazonian villages. From every woman, two samples were collected by cotton swab; one for cytological examination and the other for ethanol-preservation of cervical epithelial cells for HPV DNA testing. High molecular DNA was extracted from the ethanol-preserved cervical epithelial cells and tested for HPV DNA by a PCR-RFLP protocol. Ethanol-preserved cervical epithelial cells remained suitable for DNA isolation and PCR amplification of human β-globin and HPV E6/E7 genes, 25 days after sample collection in the field. HPV-31, HPV-58 and HPV-6 were detected in the studied population. The overall prevalence of HPV infection among Bolivian Amazonian women was 8.0%. Neither dual nor multiple HPV infections were found in any of the positive samples. This is the first report of HPV prevalence and type distribution among Bolivian Amazonian women. Our new method for preservation of cervical epithelial cells in ethanol may be useful for viro-epidemiological studies in rural areas. [author abstract] [Asian Pacific J Cancer Prev, 2, 135-141, 2001]
- Influence of helminth infections on childhood nutritional status in lowland Bolivia
Infectious disease, such as diarrheal disease, respiratory infections, and parasitic infections, are an important source of nutritional and energetic stress in many populations. Inspired by the research and methodological innovations of A. Roberto Frisancho, this paper considers the impact of childhood environment and local disease ecology on child health and nutritional patterns among an indigenous group in lowland Bolivia. Specifically, we examine the association between soil-transmitted helminth infection, especially hookworm species, and anthropometric markers of short and long-term nutritional status. Fecal samples, anthropometric dimensions, and health interviews were collected for 92 children ranging in age from 2.0 to 10.9 years. Microscopic examination revealed high levels of parasitic infection, with 76% of children positive for hookworm species infections (77% of girls and 74% of boys). Less common infections included Ascaris lumbricoides, Trichurius trichiura and Strongyloides stercoralis with only 15% of children positive for multiple-species infections. After adjusting for sex and age, no statistically significant associations were observed between helminth infections and the frequency of reported illness or anthropometric measures of nutritional status. These data demonstrate the difficulty of assessing nutritional impacts of endemic infections. [author abstract] [Tsimané Amazonian Panel Study Working Paper #49]
- Maternal education and child nutritional status in Bolivia: finding the links
This study models various pathways linking maternal education and child nutritional status in Bolivia, using a national sample of children. Pathways examined include socioeconomic status, health knowledge, modern attitudes towards health care, female autonomy, and reproductive behavior. The data come from the 1998 Bolivia Demographic and Health Survey. Logistic regression results suggest that socioeconomic factors are the most important pathways linking maternal education and child nutritional status, and that modern attitudes about health care also explain the impact of education. Health care knowledge accounts for less of the effect of maternal education on child nutritional status, with autonomy being the weakest pathway. Other pathways, such as reproductive behaviors, appear to influence nutritional status independent of maternal education. Overall, the pathways examined accounted for 60 percent of the effect of maternal education on child nutritional status. [author abstract] [Social Science & Medicine 60 (2005) 395–407]
- Nutritional status of Amerindian children from the Beni River (lowland Bolivia) as related to environmental, maternal and dietary factors
Objectives: To report the nutritional status of children aged up to 15 years and their mothers living in a remote Amazonian area of Bolivia, and to study its main social, familial and maternal determinants. Setting: Fifteen Beni River communities located at the foot of the Andes. Design: Cross-sectional survey of riverside populations. All childbearing mothers and their children in the 15 communities were examined. Methods: Information on household production, dietary habits and demography was collected. Individual clinical, anthropometric and parasitological examinations were carried out. Subjects: A total of 631 persons were examined: 171 mothers and 460 children and adolescents aged 0 to 15 years. Results: There were no cases of severe wasting, but 41% of 0–5-year-olds and 36% of 5–10-year-olds were stunted. Among 346 stool specimens examined, 75% were positive for at least one helminth. Diversity of food and quality of diet were satisfactory in 54% of households, but 27% had low diversity scores. Mothers were lighter and shorter than those observed at the national level: 20% had height below 145 cm. Prevalence of anaemia (42%) was also higher. In pre-school children, multivariate analysis indicated a relationship between growth retardation and household factors such as dietary quality, ethnic group and clinical state, but not maternal anthropometry. In contrast, in school-age children and adolescents, growth retardation was related to maternal characteristics. Conclusions: Growth retardation appeared mainly during the weaning period and did not seem to improve thereafter. To ameliorate this situation, an effort should be made to prevent common parasitic and infectious diseases in young children. Follow-up of pregnant mothers during pregnancy and delivery also needs to be reinforced. [author abstract] [Public Health Nutrition: 9(3), 327–335, 2006]
- Promoting Breastfeeding in Bolivia: Do Social Networks Add to the Predictive Value of Traditional Socioeconomic Characteristics?
This study tested whether the prediction of health-related knowledge (correct breastfeeding practices in this case) could be improved by including information about the composition of an individual's personal network above and beyond that predicted by his/her socioeconomic or demographic characteristics. Few studies have tested the predictive value of social networks, especially for population-based studies, despite an increased use of social networks in the past few years in several fields of health research, especially in research relating to prevention of HIV/AIDS and design of HIV/AIDS programmes. Promotion of breastfeeding practices that enhance child survival is important in Bolivia because of high infant morbidity and mortality in the country. Data on a cross-sectional urban probability sample of 2,354 women and men aged 15-49 years were collected from seven urban areas in Bolivia. Model building and the log likelihood ratio criteria were used for assessing the significance of variables in a logistic model. Results showed that the network variables added significantly (p<0.05 for knowledge of breastfeeding only with no other liquids and for knowledge of breastfeeding only with no solids p<0.01) to the predictive power of the socioeconomic variables. These results may also hold for other health research areas, increasingly using social network analysis, such as that of HIV/AIDS. [author abstract] [J Health Popul Nutr, Mar 2006; 24(1): 71-80]
- Reducing Anemia in Bolivian Children: Using "Chispitas" Multiple Micronutrient Sachets
"Seventy percent of Bolivian children between 6 and 24 months of age are anemic. Anemia, mostly due to iron deficiency, is the most frequent nutritional deficiency and a noted public health problem in Bolivia… To address this problem, in late 2005 the Micronutrient Initiative began supplying funding and technical assistance to the Pan American Health Organization (PAHO) in Bolivia and to the Bolivian Ministry of Health, with the aim of supplying sachets of multiple micronutrient sachets ("Chispitas") to all Bolivian children between 6 and 24 months of age..This is the first documented instance of a national government scaling up the free public distribution of multiple micronutrient sachets to a national level. In 2007, the program should meet its target of 100% coverage of children between the ages of 6 and 24 months." [Micronutrient Initiative, c2006]
- Undernutrition in Bolivia: Geography and Culture Matter
The prevalence of health problems and malnutrition in Bolivia is shockingly high, even relative to other developing countries. This study analyzes the association between a bidimensional measure of child health — composed of height and weight z-scores — and a set of child nutrition determinants related to physical and cultural contexts, the mother’s characteristics, household assets and access to public services. The paper seeks to identify the main determinants of child health and to measure the impact of each factor related to the bidimensional indicator. A sequential strategy is adopted in order to estimate a two-equation linear model with correlated error terms. A major finding is that geographical and cultural variables are significant determinants of nutritional status, and that the role of the mother’s anthropometrical characteristics is substantial. This study uses data from a Demographic and Health Survey (DHS) on over 3,000 children. [publication abstract] [Inter-American Development Bank, Banco Interamericano de Desarrollo, Latin American Research Network, Red de Centros de Investigación, Research Network Working Paper #R-492, April 2005]
- Urban transmission of Chagas disease in Cochabamba, Bolivia
Chagas disease is a major public health problem in Bolivia. In the city of Cochabamba, 58% of the population lives in peripheral urban districts (“popular zones”) where the infection prevalence is extremely high. From 1995 to 1999, we studied the demographics of Chagas infections in children from five to 13 years old (n = 2218) from the South zone (SZ) and North zone (NZ) districts, which differ in social, environmental, and agricultural conditions. Information gathered from these districts demonstrates qualitative and quantitative evidence for the active transmission of Trypanosoma cruzi in urban Cochabamba. Seropositivity was high in both zones (25% in SZ and 19% in NZ). We observed a high risk of infection in children from five to nine years old in SZ, but in NZ, a higher risk occurred in children aged 10-13, with odds ratio for infection three times higher in NZ than in SZ. This difference was not due to triatomine density, since more than 1,000 Triatoma infestans were captured in both zones, but was possibly secondary to the vector infection rate (79% in SZ and 37% in NZ). Electrocardiogram abnormalities were found to be prevalent in children and pre-adolescents (SZ = 40%, NZ = 17%), indicating that under continuous exposure to infection and re-infection, a severe form of the disease may develop early in life. This work demonstrates that T. cruzi infection should also be considered an urban health problem and is not restricted to the rural areas and small villages of Bolivia. [author abstract] [Mem Inst Oswaldo Cruz, Rio de Janeiro, Vol. 103(5): 423-430, August 2008]
- Wanted and Unwanted Fertility in Bolivia: Does Ethnicity Matter?
Context: In Bolivia, the total fertility rate (TFR) among indigenous populations is higher than that among the non-indigenous population. It is important to investigate whether this difference is attributable to ethnic differences in wanted or unwanted fertility. Methods: Data from the 2003 Bolivian Demographic and Health Survey were used to estimate women’s wanted and unwanted TFRs. Logistic regression analyses were conducted to examine whether women’s, men’s and couples’ characteristics were associated with use of any contraceptive method and modern methods. Results: The TFRs for indigenous and non-indigenous women were 4.3 and 3.1, respectively. The wanted fertility rate for indigenous women was nearly the same as that for non-indigenous women (2.7 and 2.6, respectively); virtually all of the ethnic difference in the TFRs was attributable to the ethnic difference in unwanted fertility. The proportion of women in need of contraception was greater among indigenous women than among non-indigenous women (26% vs.19%).In logistic regression analyses, male fertility preferences explained only a small part of the ethnic difference in contraceptive use. Conclusion: Women’s, men’s and couples’ preferences contribute only marginally to unwanted fertility, suggesting that structural factors act as obstacles to preventing unwanted fertility. [author abstract] [International Perspectives on Sexual and Reproductive Health, 2009, 35(4):166–175]
Educational Resources
Original website founded Lucien E. Schlosser and Eberhard Wenzel, 1997.
© Copyright for the The WWW Virtual Library and its logos by The WWW Virtual Library.
|
See Also
|
|