Pediatric Health in Argentina

Sarah DickesCórdoba, Argentina

February 2016

Outline

• Background information• Structure of the healthcare system• Most common pediatric diseases• Vaccination• Tobacco Use• Annual health controls• Conclusions• Significant personal experiences

• 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

• 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

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

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%

Most Common Pediatric Diseases

1. Nutrition, overweight/obesity2. Gastroenteritis3. Bronchospasm4. Bronchiolitis5. Vector-borne diseases6. Domestic and sexual abuse

Aedes aegypti mosquitoDengueChikungunyaZika

Reduviid bugChagas disease

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

Mortality Rate for Children <5 Years:Argentina compared to U.S.

13 per1,000

6.5 per1,000

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%)

Unicef (2013). “Immunization report.” Retrieved from http://www.unicef.org/immunization/files/EN-ImmSumm-2013.pdf.

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.

“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

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

Potential Strategies and Interventions

• Systems-based– Increase physical education/activity in schools– Higher cigarette taxes– Increase physician salaries

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

Profound Clinical Experiences

• Surgery: different anesthetic techniques• Hospital: adherence to isolation precautions• Medical education: student and resident roles

Me with the dermatology residents

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

The Hospital

Child and baby scales(very old equipment)

Outpatient clinic

Dental clinic

Me and Dr. Hidalgo

Family and Classmates

My Spanishinstructor, Sonia

My host family

My fellow medical students and ourprogram directors

Córdoba

“Voting doesn’t change anything. Politicians come and go, but hunger remains. Organize and fight.”

Plaza San Martín

Avenida 9 de Julio

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.