Dataset Information

Inequality in the distribution of ear, nose and throat specialists in 15 Latin American countries: an ecological study.

ABSTRACT:

Objective

To explore sociogeographical inequalities in the availability and distribution of ear, nose and throat specialists (ENTs) in 15 Latin American (LA) countries.

Design

Ecological.

Setting

Spanish and Portuguese-speaking countries of LA.The number of registered ENTs in 2017 was obtained from the National ENT Society in each country.

Outcome measures

The ENT rate/million population was calculated at the national and subnational (eg, state) level. Three measures were calculated to assess subnational distributive inequality of ENTs: (1) absolute and (2) relative index of dissimilarity; and (3) concentration index (using the Human Development Index as the equity stratifier). Finally, the ratio of ENTs/million population in the capital area compared with the rest of the country was calculated.

Results

There was more than a 30-fold difference in the number of ENTs/million population across the included countries-from 61.0 in Argentina (95% CI 58.7 to 63.4) to 2.8 in Guatemala (95%?CI 2.1 to 3.8). In all countries, ENTs were more prevalent in advantaged areas and in capital areas. To attain distributive equality, Paraguay would need to redistribute the greatest proportion of its ENT workforce (67.3%; 95%?CI 57.8% to 75.6%) and Brazil the least (18.5%; 95%?CI 17.6% to 19.5%).

Conclusions

There is high inequality in the number and distribution of ENTs between and within the 15 studied countries in LA. This evidence can be used to inform policies that improve access to ear and hearing services in the region, such as scale-up of training of ENTs and incentives to distribute specialists equally. These actions to reduce inequities, alongside addressing the social determinants of ear and hearing health, are essential to realise Universal Health Coverage.

SUBMITTER: Bright T

PROVIDER: S-EPMC6661698 | biostudies-literature | 2019 Jul

REPOSITORIES: biostudies-literature

ACCESS DATA

Publications

Inequality in the distribution of ear, nose and throat specialists in 15 Latin American countries: an ecological study.

Bright Tess T Mújica Oscar J OJ Ramke Jacqueline J Moreno Claudia M CM Der Carolina C Melendez Amarilis A Lara Ovares Ericka E Sandoval Domingues Edgar Ivan EI Santana Hernandez Diego Jose DJ Chadha Shelly S Silva Juan Carlos JC Peñaranda Augusto A

BMJ open 20190719 7

<h4>Objective</h4>To explore sociogeographical inequalities in the availability and distribution of ear, nose and throat specialists (ENTs) in 15 Latin American (LA) countries.<h4>Design</h4>Ecological.<h4>Setting</h4>Spanish and Portuguese-speaking countries of LA.The number of registered ENTs in 2017 was obtained from the National ENT Society in each country.<h4>Outcome measures</h4>The ENT rate/million population was calculated at the national and subnational (eg, state) level. Three measures ...[more]

PMID: 31326937

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Project description:Recurrent respiratory tract infections (rRTIs), of which there are three main groups-otitis media, tonsillitis and sinusopathies-are very common in paediatric populations and are associated with significant morbidity and mortality due to complications. These infections substantially reduce quality of life for paediatric patients and their families and are a significant personal, medical and economic burden on the patients, the patients' families and the healthcare system. Most rRTIs are of viral origin; however, indiscriminate use of antibiotics in their treatment has led to development of bacterial resistance. Effective management of rRTIs to reduce the burden of disease and to avoid overuse of antibiotics has become a great therapeutic challenge. New strategies for the management of paediatric rRTIs include focus on prevention using non-specific immunomodulators to boost the body's natural defences against infection and to downregulate infection- and allergen-induced airway inflammation. The oral immunomodulator, OM-85, a bacterial lysate, acts on the innate and adaptive branches of the immune system, conferring protection against viral and bacterial infections, and controls inflammation, thereby reducing tissue damage. OM-85 has demonstrated good tolerability and clinical efficacy in reducing the number and duration of RTIs in children with recurrent airway infections. It has also been reported to reduce the use of concomitant medications, including antibiotics, time to cure and school absenteeism. OM-85 is efficacious and well tolerated when administered concomitantly with inactivated influenza vaccine (IIV) and has been shown to reduce wheezing attacks induced by RTI in young children. Clinical results show that the greater the risk of rRTIs, the greater the benefit with OM-85. OM-85 may be considered a promising tool to add to the limited armamentarium of the ear, nose and throat (ENT) physician dealing with rRTIs and their complications, such as recurrent wheeze and asthma inception.

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Dataset Information

Inequality in the distribution of ear, nose and throat specialists in 15 Latin American countries: an ecological study.

Objective

Design

Setting

Outcome measures

Results

Conclusions

Publications

Inequality in the distribution of ear, nose and throat specialists in 15 Latin American countries: an ecological study.

Similar Datasets

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