Pan American Health Organization (Cuba)

Pediatric hematopoietic stem cell transplantation (HSCT) is a life-saving therapy for malignant and non-malignant hematologic diseases. However, access to this high-complexity treatment remains limited and uneven across the Andean subregion. This study aimed to evaluate the current status, capacity, and equity of pediatric HSCT programs in six Andean countries (Bolivia, Chile, Colombia, Ecuador, Peru, and Venezuela) within the framework of WHO Global Initiative of Childhood Cancer. A mixed-methods, cross-sectional situational assessment was conducted between November 2024 and January 2025 under the coordination of the Andean Health Organization (ORAS-CONHU) and the Pan American Health Organization (PAHO). Standardized national and center-level surveys (34 and 150 items, respectively) were applied to Ministries of Health and HSCT centers to collect data on infrastructure, workforce, financing, quality management, and barriers to access. Quantitative data were analyzed descriptively and validated by national committees, complemented by qualitative interviews with key stakeholders. Twenty-seven HSCT centers were identified across the subregion, revealing major disparities in access and capacity. Chile reached 100% coverage of estimated transplant needs, whereas Colombia, Peru, and Venezuela achieved 80%, 29%, and 42.5%, respectively. Bolivia and Ecuador had the lowest coverage (1.6% and 24%). Only 28% of units were pediatric-exclusive, and less than two-thirds met full quality and training standards. High-cost medicines, limited infrastructure, and shortages of specialized personnel were identified as critical barriers, whereas regional collaboration and national policies emerged as key facilitators. The study highlights significant inequities in pediatric HSCT access and capacity across the Andean subregion. Strengthening infrastructure, workforce training, financing mechanisms, and data systems, supported by sustained regional cooperation, is essential to achieve equitable, high-quality transplant care for all children.

AI development requires reliable datasets, yet today’s data supply chains face challenges in traceability, authenticity and ethical compliance. This study introduces a blockchain-assisted data integrity framework that ensures transparent and verifiable provenance for AI model training. The proposed system uses smart contracts to record data lineage, ownership, preprocessing transformations and annotation events. IPFS-based off-chain storage reduces blockchain load while ensuring immutability. A verification engine allows auditors to evaluate dataset compliance with ethical and regulatory standards, including bias mitigation and consent validation. Experiments utilized three real AI workflows: medical imaging, sentiment analysis and environmental sensor classification. Findings show a 92 percent reduction in provenance disputes and an improvement in audit efficiency by 41 percent. The system also provides tamper-resistant documentation supporting responsible AI governance. Latency tests show minimal performance impact due to parallelized validation nodes. This research demonstrates that blockchain can provide a robust backbone for ethical AI ecosystems, where transparency and trust are critical. Future work will explore confidentiality enhancements using zero-knowledge proofs.

Effective management of environmental health programs in community health centers (Puskesmas) is crucial to prevent diseases such as acute respiratory infections, diarrhea, and leptospirosis. However, existing practices often rely on reactive rather than preventive risk assessments, limiting program effectiveness. This study investigates the application of the Government Internal Control System (SPIP) in managing environmental health programs, focusing on the mediating roles of transparency and data quality, and the reinforcing role of internal audits. A qualitative descriptive approach was used through interviews with Puskesmas leaders, sanitarians, program staff, and internal auditors, combined with observations and document review. The findings show that transparency in budgeting and program activities, as well as the quality of health data, critically mediate SPIP’s effectiveness, while internal audits remain compliance-oriented. The study contributes conceptually by extending internal control literature to program outcomes and recommends integrating SPIP with transparent, data-driven, and outcome-focused monitoring to strengthen accountability.

Antecedentes. Acinetobacter baumannii es un patógeno oportunista de importancia creciente en las infecciones asociadas a la atención en salud, especialmente en unidades de cuidados intensivos (UCI), debido a su elevada capacidad de persistencia ambiental y resistencia a los antimicrobianos. En octubre del 2023 se identificó un brote de A. baumannii en una UCI de alta complejidad en Pereira, Colombia. Metodología. Se realizó un estudio epidemiológico descriptivo con diseño de casos y controles como parte de la investigación de brote. Se incluyeron seis casos confirmados de infección por A. baumannii y veinte controles hospitalizados en la UCI durante el mismo periodo. La información se obtuvo a partir de historias clínicas, registros de laboratorio (cultivo convencional y FilmArray®) y bases de datos institucionales. Se describieron las características clínicas y epidemiológicas, se estimaron las tasas de incidencia y se evaluaron los factores asociados mediante razones de disparidad (OR) con intervalos de confianza del 95 %, utilizando modelos de regresión logística ajustados por edad y sexo. Resultados. Durante el periodo de estudio se identificaron seis casos, con una tasa de incidencia de 4,8 casos por 100 días-paciente. La neumonía asociada a ventilación mecánica fue el tipo de infección más frecuente. El análisis multivariado mostró una asociación significativa entre la localización de la cama y la infección por A. baumannii, destacándose la cama 22 (OR ajustado = 91,9; IC 95 %: 1,01–2 334,1). Se observó una tendencia a mayor riesgo en pacientes con tubo orotraqueal y en aquellos ingresados durante el turno nocturno. Conclusión. El brote estuvo probablemente relacionado con factores ambientales y organizacionales dentro de la UCI, particularmente con la localización del paciente. Los hallazgos resaltan la importancia de integrar el análisis epidemiológico con la evaluación de procesos y del entorno hospitalario para orientar intervenciones oportunas y efectivas.

Abstract This chapter maps the contribution of States of the Americas to international judicialization. First, it tells the story of the many experiments in international adjudication that took place in the region during the first half of the 20th century. Then, it provides a contemporary account of patterns of participation in regional (i.e., the OAS human rights system; the Andean Tribunal of Justice; the Caribbean Court of Justice; the Central American Court of Justice; the dispute settlement systems of the Mercosur and the United States-Mexico-Canada Agreement) and global adjudicative bodies (i.e., International Court of Justice; International Tribunal for the Law of the Sea; World Trade Organization Dispute Settlement system; and the International Criminal Court).

Introduction: COVID-19 poses a serious problem to global public health. Despite vaccine availability, countries face difficulties in reaching the 70% coverage target. The objectives of this study were to estimate vaccination coverage for COVID-19 in the population aged 18 and older in Bissau, January 2023, and to assess factors associated with vaccination. Methods: A cross-sectional study was conducted using the WHO 30 by 7 cluster sampling technique. Based on this, a total of 210 interviews were estimated. Bissau’s selection was by convenience. The selection of clusters, blocks, households, and individuals to be interviewed was by simple random drawing. A vaccinated individual was defined as an eligible who provided proof, through a vaccination card or certificate, of at least one dose of the COVID-19 vaccine. Descriptive statistics, Prevalence Ratio (PR), 95% Confidence Intervals (95%CI), and Design Effect (DE) were calculated. Results: A total of 209 individuals were interviewed. The mean age was 37 (SD 0.89) years old; 59.3% (124/209) were female, 50% (104/209) were married, and 50.7% (106/209) were Christians. The vaccination coverage was 49% (102/209) with 95%CI: 42.0-56.0%, and DE=1.001. In bivariate analysis, married people (PR=1.5; [95%CI: 1.12-2.01]; DE=1.001) and having comorbidity (PR=1.37; [95%CI: 1.04-1.81]; DE=1.001) were more likely to be vaccinated. Conclusion: COVID-19 vaccination coverage in Bissau remained below the 70% target. Being married and getting vaccinated was an unusual finding that needs further study. The findings highlight the need for intensified vaccination campaigns and personalised strategies to improve coverage, particularly among unmarried individuals and those without comorbidities.

Hemolytic uremic syndrome associated to Shiga toxin-producing Escherichia coli infection (STEC-HUS) is a life-threatening condition characterized by microangiopathic hemolytic anemia, thrombocytopenia, and acute kidney failure. Among STEC, E. coli O157:H7 is the dominant serotype related with human disease worldwide; however, a subset of STEC non-O157 serotypes -named the “Big-Six”- that include the E. coli serogroups O145, O121, O26, O111, O103 and O45 became of a great concern for their potential to cause HUS. Previously, we have demonstrated that serological tests based on bacterial engineered glycoconjugates developed by exploiting the Campylobacter jejuni N-glycosylation machinery, notably increases the association rate of HUS to O157, O145 and O121 STEC infections. In this work, we developed the recombinant glycoproteins O26-AcrA, O111-AcrA, O103-AcrA and O45-AcrA by co-expressing in E. coli the gene cluster required for the synthesis of the O polysaccharide corresponding to each serogroup, the C. jejuni oligosaccharyltransferase (OTase) PglB, and the carrier protein AcrA. The glycans attached to AcrA in the produced and purified glycoconjugates were characterized by mass spectrometry. The glycoconjugates were evaluated as antigens for detection of IgM antibodies against the O polysaccharide of the lipopolysaccharide of O26, O111 and O103 STEC strains in human serum samples. Our results demonstrate that O26-AcrA, O111-AcrA and O103-AcrA allow a clear discrimination between negative and positive samples obtained from patients with HUS associated to O26, O111 and O103 STEC infections. Additionally, these novel antigens are serospecific allowing E. coli serogroup identification which may contribute to the epidemiological surveillance of STEC-HUS patients and their contacts.

Cardiovascular diseases remain the leading cause of premature morbidity and mortality globally, with hypertension as their main modifiable risk factor. In Latin America and the Caribbean, hypertension affects more than 30% of adults, yet control rates remain alarmingly low. The HEARTS in the Americas Initiative, led by the Pan American Health Organization, promotes a model of team-based care to enhance risk management for hypertension and cardiovascular diseases within primary health care. Team-based care leverages the skills of diverse health professionals, including nurses, pharmacists and community health workers, to optimize resource allocation, task-sharing and care delivery. Evidence underscores the effectiveness of team-based care in improving blood pressure control, reducing hospitalizations and enhancing quality of life through strategies such as periodic follow up and medication titration. Despite its benefits, implementing team-based care faces cultural and systemic barriers. This special report outlines a policy framework to scale team-based care across the Region of the Americas, ensuring equitable access to high-quality, cost-effective prevention and care for cardiovascular diseases.

ABSTRACT Objective: to analyze the profile of late maternal deaths that occurred in Brazil between 2010 and 2019, based on sociodemographic characteristics and research data. Method: ecological time series study based on data from the Mortality Information System and the Live Birth Information System for the period 2010 to 2019. The Prais-Winsten autoregressive model was applied to the Late Maternal Mortality Ratio. Results: a total of 1,470 late maternal deaths were reported, corresponding to a Late Maternal Mortality Ratio of 5/100,000 live births, which represents 8.7 % of the total Maternal Mortality Ratio in the period analyzed. The Late Maternal Mortality Ratio in Brazil showed, between 2010 and 2019, an increasing trend with an average annual percentage change of 9.79 % (95 %CI 4.32-15.54). There was growth among black women (8.01 %; 95 %CI 2.47 - 13.86), the strata with the lowest level of education, and in the age groups between 15 and 34 years. In 83.7 % of the late maternal deaths reported, there was an investigation with marked regional disparity. Indirect causes were the most prevalent. Conclusion: the results point to the invisibility and vulnerability of specific groups regarding late maternal mortality in Brazil, reinforcing the need for equitable policies and an improved model of care and monitoring during the postpartum period.