Ana Maria Osorio

Intermediary and Structural Determinants of Early Childhood Health in Colombia: Exploring the Role of Communities

This study examines how structural determinants influence intermediary factors of child health inequities and how they operate through the communities where children live. In particular, we explore individual, family and community level characteristics associated with a composite indicator that quantitatively measures intermediary determinants of early childhood health in Colombia. We use data from the 2010 Colombian Demographic and Health Survey (DHS). Adopting the conceptual framework of the Commission on Social Determinants of Health (CSDH), three dimensions related to child health are represented in the index: behavioural factors, psychosocial factors and health system. In order to generate the weight of the variables and take into account the discrete nature of the data, principal component analysis (PCA) using polychoric correlations are employed in the index construction. Weighted multilevel models are used to examine community effects. The results show that the effect of household’s SES is attenuated when community characteristics are included, indicating the importance that the level of community development may have in mediating individual and family characteristics. The findings indicate that there is a significant variance in intermediary determinants of child health between-community, especially for those determinants linked to the health system, even after controlling for individual, family and community characteristics. These results likely reflect that whilst the community context can exert a greater influence on intermediary factors linked directly to health, in the case of psychosocial factors and the parent’s behaviours, the family context can be more important. This underlines the importance of distinguishing between community and family intervention programmes.

Social Determinants of Child Health in Colombia: Can Community Education Moderate the Effect of Family Characteristics?

Contextual effects on child health have been investigated extensively in previous research. However, few studies have considered the interplay between community characteristics and individual-level variables. This study examines the influence of community education and family socioeconomic characteristics on child health (as measured by height and weight-for-age Z-scores), as well as their interactions. We adapted the Commission on Social Determinants of Health (CSDH) framework to the context of child health. Using data from the 2010 Colombian Demographic and Health Survey (DHS), weighted multilevel models are fitted since the data are not self-weighting. The results show a positive impact of the level of education of other women in the community on child health, even after controlling for individual and family socioeconomic characteristics. Different pathways through which community education can substitute for the effect of family characteristics on child nutrition are found. The interaction terms highlight the importance of community education as a moderator of the impact of the mother’s own education and autonomy, on child health. In addition, the results reveal differences between height and weight-for-age indicators in their responsiveness to individual and contextual factors. Our findings suggest that community intervention programmes may have differential effects on child health. Therefore, their identification can contribute to a better targeting of child care policies.

Individual and local level factors and antenatal care use in Colombia: a multilevel analysis

This paper examined the association between individual and local level factors and the number of antenatal care visits completed by women in Colombia using data from the 2010 Colombian Demographic and Health Survey and multilevel logistic regression models. Our findings suggest that, in addition to maternal socioeconomic status, contextual factors influence whether pregnant women complete the minimum recommended number of antenatal care visits. These factors include: level of womens autonomy in the community, regional inequalities and access barriers caused by distance (OR = 0.057), costs of services (OR = 0.035), and/or a lack of confidence in doctors (OR = 0.036). Our results highlight the existence of inequalities in access to antenatal care and the importance of considering the local context in the design of effective maternal care policies in Colombia. Furthermore, our findings regarding individual factors corroborate the evidence from other countries and offer new insights into the association between local level factors and number of antenatal care visits.

Community socioeconomic context and its influence on intermediary determinants of child health: Evidence from colombia

Intermediary determinants are the most immediate mechanisms through which socioeconomic position shapes health inequities. This study examines the effect of community socioeconomic context on different indicators representing intermediary determinants of child health. In the context of Colombia, a developing country with a clear economic expansion, but one of the most unequal countries in the world, two categories of intermediary determinants, namely behavioural and psychosocial factors and the health system, are analysed. Using data from the 2010 Colombian Demographic and Health Survey (DHS), the results suggest that whilst the community context can exert a greater influence on factors linked directly to health, in the case of psychosocial factors and parents behaviours, the family context can be more important. In addition, the results from multilevel analysis indicate that a significant percentage of the variability in the overall index of intermediary determinants of child health is explained by the community context, even after controlling for individual, family and community characteristics. These findings underline the importance of distinguishing between community and family intervention programmes in order to reduce place-based health inequities in Colombia.

Fatores individuais e em nível comunitário do uso de cuidados pré-natais na Colômbia: uma análise multinível

This paper examined the association between individual and local level factors and the number of antenatal care visits completed by women in Colombia using data from the 2010 Colombian Demographic and Health Survey and multilevel logistic regression models. Our findings suggest that, in addition to maternal socioeconomic status, contextual factors influence whether pregnant women complete the minimum recommended number of antenatal care visits. These factors include: level of womens autonomy in the community, regional inequalities and access barriers caused by distance (OR = 0.057), costs of services (OR = 0.035), and/or a lack of confidence in doctors (OR = 0.036). Our results highlight the existence of inequalities in access to antenatal care and the importance of considering the local context in the design of effective maternal care policies in Colombia. Furthermore, our findings regarding individual factors corroborate the evidence from other countries and offer new insights into the association between local level factors and number of antenatal care visits.

Factores a nivel individual y comunitario y el uso de controles prenatales en Colombia: un análisis multinivel

This paper examined the association between individual and local level factors and the number of antenatal care visits completed by women in Colombia using data from the 2010 Colombian Demographic and Health Survey and multilevel logistic regression models. Our findings suggest that, in addition to maternal socioeconomic status, contextual factors influence whether pregnant women complete the minimum recommended number of antenatal care visits. These factors include: level of womens autonomy in the community, regional inequalities and access barriers caused by distance (OR = 0.057), costs of services (OR = 0.035), and/or a lack of confidence in doctors (OR = 0.036). Our results highlight the existence of inequalities in access to antenatal care and the importance of considering the local context in the design of effective maternal care policies in Colombia. Furthermore, our findings regarding individual factors corroborate the evidence from other countries and offer new insights into the association between local level factors and number of antenatal care visits.

Duración del desempleo de los graduados en ciencias económicas y administrativas e ingenierías en Cali 2001-2006 (Duration of Unemployment of Graduates in Economic and Administrative Sciences and Engineering in Cali 2001-2006)

Spanish Abstract: La duracion del desempleo en Colombia y en el area metropolitana de Cali ha sido estudiada generalmente teniendo en cuenta el mercado en su conjunto pues no se cuenta con estadisticas que permitan segmentar el mercado entre calificados y no calificados. En el presente trabajo, usando informacion primaria de los egresados de cuatro universidades de Cali: Pontificia Universidad Javeriana, Universidad del Valle, Universidad Libre y Universidad Autonoma de Occidente, se identificaron los principales determinantes de la duracion del desempleo de los profesionales en las ciencias economicas y administrativas e ingenieria, y su relacion con estudios en Colombia, durante el periodo 2001-2006 con base en la cohorte del ano 2004 y aplicando, para el caso del tiempo discreto, la metodologia sugerida en los modelos de Prentice y Gloeckler (1978) y de Mayer (1990). Los resultados indican que el genero, la edad y las aspiraciones salariales son factores que determinan tanto en el tiempo de busqueda como en el riesgo de permanecer mas tiempo en el, ademas del perfil profesional, de hecho, los profesionales con menor tiempo de busqueda son los de ciencias economicas y administrativas. English Abstract: The duration of unemployment in Colombia and in the metropolitan area of Cali in particular, has been studied here in a broad sense, considering the market as a whole, since there are no statistics that allow the segmentation of the market between qualified and unqualified people. Based on primary data of graduates from four universities in Cali: Pontificia Universidad Javeriana, Universidad del Valle, Universidad Libre and Universidad Autonoma de Occidente, this study made it possible to determine the main factors relating to the duration of unemployment of graduates in economic and administrative sciences and engineering, covering university study in Colombia during the period 2001-2006, based on the cohort of 2004 and the methodology suggested in the models of Prentice and Gloeckler (1978) and Mayer (1990), which are applied for the case of discrete time. Results show that gender, age and salary aspiration are factors that determine the search time and the risk of spending more time in this activity, as well as the professional profile. In fact, graduates who spend less time searching are those engaged in the economic and management sciences.

Determinantes Del Uso De Los Servicios De Salud Materna En El Litoral Pacífico Colombiano (Determining Factors of the Use of Maternal Health Services in the Colombian Pacific Coast)

Spanish Abstract: El presente articulo analiza determinantes (individuales y de contexto) que inciden en el uso de servicios de atencion en salud por parte de las madres antes, durante y despues del parto en el Litoral Pacifico Colombiano. Para este objetivo se construyen indicadores estadisticos y se estiman modelos de regresion binaria a partir de microdatos de la Encuesta Nacional de Demografia y Salud 2005 y del Registro Especial de Prestadores de Servicios de Salud del Ministerio de la Proteccion Social de Colombia. Los resultados muestran que los factores que mas inciden en el uso de los servicios de salud materna en su orden son: la afiliacion a un regimen de seguridad social en salud, el orden de nacimiento de los hijos, el nivel de educacion y el lugar de residencia de la madre. English Abstract: This article analyzes determinants (individual and text related) that affect the use of health services by women before, during and after birth, on the Colombian Pacific coast. For this purpose, statistical indicators are designed, and binary regression models are estimated from microdata from the National Demographic and Health Survey 2005, and the Special Register of Health Care Providers of the Colombian Ministry of Social Protection. The results show that the factors that most affect the use of maternal health services are, in order: affiliation to a social security health regime, the order in which the children are born, the level of education and the mothers place of residence.