Pediatric Health in Argentina Health in Argentina Presentation.pdf• Lung cancer is considered an...
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Pediatric Health in Argentina
Sarah DickesCórdoba, Argentina
February 2016
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Outline
• Background information• Structure of the healthcare system• Most common pediatric diseases• Vaccination• Tobacco Use• Annual health controls• Conclusions• Significant personal experiences
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• Population of Argentina: 43 million• Population of Córdoba: 1.6 million
(2nd largest city)• 33.6% of population between 0-19
years old• High income level nation• Primary cultural influences:
Italian, Spanish, German• 92% Catholic• 6 military coups from 1930-1976• Representative democratic republic
Background Information
SOUTH AMERICA
Córdoba
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• Public, provincial hospital• Services offered:
– Outpatient and inpatient care– Emergency services– Pediatric ICU– Dental clinic– Specialty services
(pulmonology, cardiology, ophthalmology, gastroenterology, etc.)
Clinical Site: Hospital Pediátrico del Niño Jesús
Entrance to HospitalPediátrico del Niño Jesús
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Why Pediatric Health in Argentina?
• Relevant to my profession• Explore similarities and
differences between Argentina and the U.S.
• Introduce a variety of important pediatric topics rather than one specific topic
Entrance to the Emergency Room
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Structure of the Healthcare System
• Public system– Government-funded
• Social security system– Employer and employee-
funded• Private system
– Patients pay out of pocket or have private insurance
Types of Hospitals:Hospitals are either national, regional, or provincial hospitals.
Proportion of Argentinians utilizing each system
Public
SocialSecurity
Private49%
44%
7%
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Most Common Pediatric Diseases
1. Nutrition, overweight/obesity2. Gastroenteritis3. Bronchospasm4. Bronchiolitis5. Vector-borne diseases6. Domestic and sexual abuse
Aedes aegypti mosquitoDengueChikungunyaZika
Reduviid bugChagas disease
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Most Common Causes of Death
Children <5 years:1. Congenital malformations2. Accidents/injuries3. Infection
Children 6-10 years:1. Pathologies
Adolescents (10-18):1. Accidents/injuries2. Suicide3. Homicide
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Mortality Rate for Children <5 Years:Argentina compared to U.S.
13 per1,000
6.5 per1,000
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Vaccination in Argentina
• Immunization schedule contains 19 vaccines• 2009 – immunization became required, free of charge• 2009-2012 – HPV, dengue fever, and pneumococcal vaccines
added to schedule• 2015 – Rotavirus added• Very minimal anti-vaccination movement, if any• Comprehensive schedule, high vaccination rates (93-99%)
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Unicef (2013). “Immunization report.” Retrieved from http://www.unicef.org/immunization/files/EN-ImmSumm-2013.pdf.
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Tobacco Use
• Global Youth Tobacco Survey: 25% of 13-15 year olds in Argentina smoke; 30% of Argentine 11-year-olds have tried smoking already.1
• Lung cancer is considered an endemic disease in Argentina.
Gender Youth cigarettesmoking (2012)1
Youth cigarette smoking (2015)2
Youth smokeless tobacco use (2014)2
Male 17.4% 17.0% 4.4%
Female 21.4% 20.5% 3.0%
Both sexes 19.6% 18.8% 3.7%
1. “Tobacco Use Among Youths — Argentina, 2007 and 2012.” Morbidity and Mortality Weekly Report (MMWR). Retrieved from http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6327a3.htm.
2. World Health Organization (2015). “WHO Report on the Global Tobacco Epidemic, 2015.” Retrieved from http://www.who.int/tobacco/surveillance/policy/country_profile/arg.pdf.
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“Controles de Salud”(Annual Health Controls)
• Required annual health checks for clearance to attend school– General pediatrician (vaccines)– Cardiologist (EKG)– Ophthalmologist (vision screening)– Dentist (annual dental care)
A child receiving dentalcare in the dental clinic
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Potential Strategies and Interventions
• Individual-based– Improve nutrition– Reduce screen time and encourage physical activity– Smoking cessation
• Community-based– Nutrition education– Community sports teams or physical activity events– Healthy cooking classes/events– Improve access to healthy foods in rural areas
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Potential Strategies and Interventions
• Systems-based– Increase physical education/activity in schools– Higher cigarette taxes– Increase physician salaries
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Conclusions
• Obesity and poor nutrition are global health problems
• Although the U.S. healthcare system has its pitfalls, I have a greater appreciation for certain aspects of it
• The U.S. could learn some lessons from Argentina to improve American pediatric health
• Differences in patient care often have to do with a lack of resources in the public hospitals
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Profound Clinical Experiences
• Surgery: different anesthetic techniques• Hospital: adherence to isolation precautions• Medical education: student and resident roles
Me with the dermatology residents
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Profound Cultural Experiences
• Physician salaries compared to other sectors• Food (positive and negative aspects)
– Pastries, wine, yerba mate– Awareness of nutritional value and cooking styles
EmpanadasYerba mate Alfajores
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The Hospital
Child and baby scales(very old equipment)
Outpatient clinic
Dental clinic
Me and Dr. Hidalgo
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Family and Classmates
My Spanishinstructor, Sonia
My host family
My fellow medical students and ourprogram directors
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Córdoba
“Voting doesn’t change anything. Politicians come and go, but hunger remains. Organize and fight.”
Plaza San Martín
Avenida 9 de Julio
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References1. Average Salary Survey (2016). “Argentina.” Retrieved from http://www.averagesalarysurvey.com/argentina. 2. “Calendario Nacional de Vacunación 2016.” Ministerio de Salud: Presidencia de la Nación. Retrieved from
http://www.msal.gob.ar/index.php/home/funciones/consultas-por-mail/184-calendario-nacional-de-vacunacion-2016. 3. “Global Adult Tobacco Survey: Argentina 2012.” Retrieved from
http://www.who.int/tobacco/surveillance/survey/gats/argentina_fact_sheet_2012.pdf. 4. Hill, Anna (2011). “Expanding Waistlines: Obesity in Argentina.” The Argentina Independent. Retrieved from
http://www.argentinaindependent.com/currentaffairs/newsfromargentina/expanding-waistlines-obesity-in-argentina/. 5. Index Mundi. “Argentina Demographics Profile 2014.” Retrieved from http://www.indexmundi.com/argentina/demographics_profile.html. 6. Keetch, Olivia (2008). “Smoking in Argentina: Youth Targeted?” The Argentina Independent. Retrieved from
http://www.argentinaindependent.com/socialissues/urbanlife/smoking-in-argentina-youth-targetted/. 7. Pan American Health Organization (2012). “Argentina.” Health in the Americas. Retrieved from
http://www.paho.org/saludenlasamericas/index.php?option=com_docman&task=doc_view&gid=111&Itemid=. 8. “Tobacco Use Among Youths — Argentina, 2007 and 2012.” Morbidity and Mortality Weekly Report (MMWR). Retrieved from
http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6327a3.htm. 9. Unicef (2013). “Immunization report.” Retrieved from http://www.unicef.org/immunization/files/EN-ImmSumm-2013.pdf.10. Wikipedia. “Politics of Argentina.” Retrieved from https://en.wikipedia.org/wiki/Politics_of_Argentina. 11. The World Bank 2016). “Argentina.” Retrieved from http://data.worldbank.org/country/argentina. 12. The World Bank (2016). “Mortality rate, under 5 (per 1,000). Retrieved from
http://data.worldbank.org/indicator/SH.DYN.MORT/countries/AR-US?display=graph. 13. “World Development Indicators, November 2015.” Retrieved from http://knoema.com/WBWDIGDF2015Oct/world-development-indicators-
wdi-november-2015?tsId=1310480. 14. World Health Organization (2015). “WHO Report on the Global Tobacco Epidemic, 2015.” Retrieved from
http://www.who.int/tobacco/surveillance/policy/country_profile/arg.pdf.