The Institute for Global Health and Development
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Item Utilización de los servicios médicos en un área de salud(Editorial Ciencias Médicas, 2013-01) Díaz Piñera, Addys; Rodríguez Salvá, Armando; García Roche, René; Balcindes, Susana; Jova Morel, Rodolfo; De Vos, Pol; Van der Stuyft, PatrickIntroducción: en la utilización de los servicios de salud convergen no solo la necesidad de atención de la población en términos de enfermedad, sino sus creencias y aspectos culturales; pero, sobre todo, el complejo contexto en que se da la prestación de servicios. Objetivo: exponer las características sociodemográficas y las enfermedades o sintomatologías más frecuentes en la población del área de salud "Marcio Manduley", del municipio Centro Habana, y los que hicieron uso de los servicios de salud durante el período abril - junio de 2010. Métodos: estudio descriptivo transversal. Se seleccionó una muestra poblacional representativa del área; se tomó en consideración el total de viviendas. Como se desconoce la prevalencia del factor bajo estudio, se maximizó la muestra tomando como prevalencia el 50 %, la precisión en 10 % y una posible caída muestral del 10 %. El tamaño muestral fue de 408 familias. Se aplicaron cuestionarios a todos los integrantes de las familias seleccionadas y en particular a aquellos individuos que durante los últimos 30 días enfermaron e hicieron uso de algún servicio de salud. Resultados: se obtuvieron datos de 1 244 personas; de ellas enfermaron 25,1 % en los últimos 30 días y el 17,7 % hizo uso de servicios formales de salud. Las enfermedades más frecuentes fueron respiratorias, cardiovasculares y osteomioarticular. La puerta de entrada al sistema de salud más utilizada fue el consultorio médico (54,1 %). Conclusiones: en nuestro estudio los factores del individuo que influyen en la utilización de los servicios de salud son el nivel de enfermedad percibida o necesidad de salud y el sexo.Item The direct costs of home care in Cuba(Organización Panamericana de la Salud, 2007) Barroso Utra, Isabel M.; García Fariñas, Anai; Rodríguez Salvá, Armando; De Vos, Pol; Bonet‐Gorbea, Mariano; Van der Stuyft, PatrickOBJECTIVE: To analyze home care services in Cuba and determine how length of stay, per-day cost, and per-patient cost vary by diagnosis and by the area of the country in which the services are rendered.Item Public health services, an essential determinant of health during crisis. Lessons from Cuba, 1989–2000(Wiley, 2012-02-01) De Vos, Pol; García‐Fariñas, Anaí; Álvarez‐Pérez, Adolfo; Rodríguez Salvá, Armando; Bonet‐Gorbea, Mariano; Van der Stuyft, PatrickDuring the 1990s, Cuba was able to overcome a severe crisis, almost without negative health impacts. This national retrospective study covering the years 1989–2000 analyses the country’s strategy through essential social, demographic, health process and health outcome indicators. Gross domestic product (GDP) diminished by 34.76% between 1989 and 1993. In 1994 slow recuperation started. During the crisis, public health expenses increased. The number of family doctors rose from 9.22 to 27.03 per 104 inhabitants between 1989 and 2000. Infant mortality rate and life expectancy exemplify a series of health indicators that continued to improve during the crisis years, whereas low birth weight and tuberculosis incidence are among the few indicators that suffered deterioration. GDP is inversely related to tuberculosis incidence, whereas the average salary is inversely related to low birth weight. Infant mortality rate has a strong negative correlation with the health expenses per inhabitant, the number of maternal homes, the number of family doctors and the proportion of pregnant women receiving care in maternal homes. Life expectancy has a strong positive correlation with health expenses, the number of nursing personnel and the number of medical contacts per inhabitant. The Cuban strategy effectively resolved health risks during the crisis. In times of serious socio‐economic constraints, a well conceptualized public health policy can play an important role in maintaining the overall well‐being of a population.Item Assessment of hypertension management and control: A registry-based observational study in two municipalities in Cuba(BioMed Central, 2019-01-30) Londoño Agudelo, Esteban; Rodríguez Salvá, Armando; Díaz Piñera, Addys; García Roche, René; De Vos, Pol; Battaglioli, Tullia; Van der Stuyft, PatrickBackground - To determine the prevalence of hypertension treatment and control among hypertensive patients in the Cuban municipalities of Cardenas and Santiago and to explore the main associated predictors. Methods - Cross-sectional study, with multistage cluster sampling, conducted between February 2012 and January 2013 in two Cuban municipalities. We interviewed and measured blood pressure in 1333 hypertensive patients aged 18 years or older. Hypertension control was defined as blood pressure lower than 140/90 mmHg. Results - The mean age ± standard deviation (SD) of participants was 59.8 ± 14 years, the mean systolic and diastolic blood pressure ± SD was 130.0 ± 14.4 and 83.1 ± 9.0 mmHg respectively. The majority of patients (91, 95%CI 90–93) were on pharmacological treatment, 49% with a combination of 2 or more classes of drugs. Among diagnosed hypertensive patients 58% (95%CI 55–61) had controlled hypertension. There was no association between hypertension control and gender, age and socio-economic condition. Levels of hypertension control depended on health area and control furthermore was positively associated with post-primary education, not being obese and white ethnicity: adjusted Odds Ratio (95% CI) 1.71 (1.26–2.34), 1.43 (1.09–1.88) and 1.41 (1.09–1.81) respectively. Conclusions - The observed figures are outstanding at the international level and illustrate that hypertension treatment and control are achievable in a resource-constrained setting such as Cuba. The country’s primary health care approach and social equity in access to health care can be seen as key determinants of this success. Nevertheless, there is still room for improvement, as over a third of patients did not have controlled hypertension.Item Morbidity, utilization of curative care and service entry point preferences in metropolitan Centro Habana, Cuba(Scientific Electronic Library Online, 2016-11-03) Rodríguez Salvá, Armando; Díaz Piñera, Addys; Balcindes, Susana; García Roche, René; De Vos, Pol; Van der Stuyft, PatrickFirst-line health services with a primary health care approach are a strong trigger for adequate health-care-seeking behavior. Research on the association between prevalence of chronic diseases and acute illnesses and use of health services emphasizes the importance of socioeconomic determinants in such patterns of utilization. In a cross-sectional study of 408 families in Centro Habana, Cuba, home interviews were conducted between April and June 2010 to analyze socio-demographic determinants of acute and chronic health problems and use of formal health services. Bivariate and logistic regression models were used. 529 persons reported a chronic disease. During the previous month, 155 of the latter reported an exacerbation and 50 experienced an unrelated acute health problem. 107 persons without chronic diseases reported acute health problems. Age was the strongest determinant of chronic disease prevalence. Adult women and the elderly were more likely to report acute problems. Acute patients with underlying chronic disease used formal services more often. No socio-demographic variable was associated with services use or consultation with the family physician. While the family physician is defined as the system's entry-point, this was the case for only 54% of patients that had used formal services, thus compromising the physician's role in counseling patients and summarizing their health issues. The importance of chronic diseases highlights the need to strengthen the family physician's pivotal role. New economic policies in Cuba, stimulating self-employment and private initiative, may increase the strain on the exclusively public health care system. Still, the Cuban health system has demonstrated its ability to adapt to new challenges, and the basic premises of Cuba's health policy are expected to be preserved.