Published also as Thesis (Ph. D.)--Columbia University, 1930. / "Notes" (Bibliography): p. 159.

Philosophiae Doctor - PhD / This study is based on the assumption that the under-five mortality rate, in recent decades, has declined, particularly in developing countries. However, all the social strata across many countries do not seem to benefit from this reduction of mortality - and mortality remains abnormally high among children especially those from underprivileged social strata. This research is, therefore, a holistic approach to analyse and quantify the inequalities of health among children under five in sub-Saharan Africa over the last two decades (1990-2010). The research sought to investigate the trend and determinants of health inequalities of under-five years (mortality and morbidity) in sub-Saharan Africa (SSA) from 1990 to 2010. An essential point has been devoted to the decomposition of effects and analysis of the contribution of the factors explaining these inequalities. The data used in the study come from Demographic and Heath Surveys (DHS) done between 1990 and 2015 in sub-Saharan Africa countries. In order to analyse the inequalities in trends of mortality and morbidity of children, different selected countries that have conducted at least three DHS during the 1990-2010 period. Several statistical methods were used for data analysis. There were four chapters which is prepared with an article style. For the first paper titled "Decomposing Inequalities in Under- Five Mortality in Selected African Countries", concentration index (CI) and Generalised Linear Model (GLM) with a logit link were used to analyse and measure under 5 mortality inequalities and the associated factors. This paper has been published in the Iranian Journal of Public Health. For the second paper titled "Determinants of Under-Five Mortality in Burkina Faso: A Concentration Dimension". The study used logistics regression and Oaxaca-Blinder decomposition method for the binary outcome to analyse data was involved. For data analysis of the third paper titled "Women Education, Health Inequalities in Under-Five Mortality in sub-Saharan Africa, 1990 – 2013", logistic regression and Bius's decomposition method were used to examine the effect of mother's education level on childhood mortality. In the fourth paper titled "Trends and Risk Factors for Childhood Diarrheal in sub-Saharan Countries (1990-2010): Assessing the Neighbourhood Inequalities", a multilevel logistic regression modelling was used to determine the fixed and random effects of the risk factors associated with the diarrheal morbidity. The work carried out during this on-going thesis helps to understand the magnitude of inequalities in under-five mortality in sub-Saharan countries. The findings showed that the contributing factors of inequalities of child mortality were birth order, maternal age, parity and household size. With regards to the relationship between mother's education level and inequalities in mortality of children under-five in sub-Saharan Africa, findings showed that children of mothers who did not attend school have a higher rate of death compared to those who had been to school. However, we have observed that the inequalities have narrowed over time. The results showed the risk factors of diarrheal morbidity varied from one country to another, but the main factors included: child's age, the size of the child at birth, the quality of the main floor material, mother's education and her occupation, type of toilet, and place of residence. In conclusion, the results of this study show that inequalities in under-five mortality are still important among different social strata in sub-Saharan Africa countries. It is then urgent to take actions to save the lives of children in disadvantaged social strata. / National Research Foundation

Orientador: Maria da Luz Rosário de Sousa / Tese (doutorado) - Universidade Estadual de Campinas, Faculdade de Odontologia de Piracicaba / Made available in DSpace on 2018-08-23T00:06:37Z (GMT). No. of bitstreams: 1 Batista_MariliaJesus_D.pdf: 1458507 bytes, checksum: 08ecbff2e76750f8dab4b68e6096e428 (MD5) Previous issue date: 2013 / Resumo: Objetivo: Este estudo avaliou o impacto da perda dentária na qualidade de vida em adultos utilizando índices de mortalidade e verificou os fatores associados. Metodologia: No estudo transversal foi avaliados a experiência de cárie dentária (CPOD), necessidade de tratamento, condição periodontal (CPI), presença de biofilme dental, dados demográficos, socioeconômicos, de autopercepção, uso de serviços odontológicos e qualidade de vida relacionada à saúde bucal (OHIP-14). No capítulo 1, foram utilizados dados secundários de 386 adultos trabalhadores, de 20-64 anos aplicando os índices de mortalidade dentária (P/CPO) (IMD) e índice de mortalidade dentária modificado (IMDM). Realizaram-se modelos de regressão Poisson, sendo o desfecho, o quartil 75% da distribuição de cada índice. Para os capítulos 2 e 3, coletaram-se dados, por amostragem probabilística, de 248 adultos (20-64 anos), em domicílios de Piracicaba. O número de dentes perdidos e a posição que eles ocupavam na arcada foram considerados para verificar o impacto da perda dentária na qualidade de vida. No capítulo 2 os desfechos foram: prevalência de impactos severos (frequentemente/sempre) e severidade do OHIP (escore total. No capítulo 3 o desfecho foi à classificação da perda dentária. Na análise dos dados foram realizados modelos de regressão logística binária, regressão log-binomial negativa e regressão logística multinomial, com abordagem hierárquica utilizando modelos conceituais teóricos. Resultados: O último quartil do IMD foi 50% e do IMDM, 44,1%. Ser mais velho e presença de biofilme dental foram associados à mortalidade dentária. Renda familiar mais baixa (RP=1,58, IC95%=1,02-2,45); e uso irregular de fio dental (RP=1,66, IC95%=1,05-2,63) foi associados ao maior quartil do IMD; baixa escolaridade (RP=1,55, IC95%=1,01-2,39); e procurar o dentista motivado pela dor (RP=1,84, IC95%=1,11-3,04) ao IMDM. A média do OHIP nos adultos foi 10,21 (EP=1,16), e 48,1% (n=115) relataram impactos sempre/frequentemente. Foram indicadores de risco para OHIP severidade perdas até 12 dentes, incluindo um ou mais dentes anteriores (RRP=1,63, IC95%=1,06-2,51), perdas de 13 a 31 dentes (RRP=2,33, IC95%=1,49- 3,63), e os edêntulos (RRP=2,66, IC95%=1,55-4,57). O atendimento odontológico motivado por dor ou necessidade de tratamento e ter dentes cariados foram associados. A prevalência de impactos severos foi associada ao uso dos serviços odontológicos por dor, ter dentes cariados e baixa renda. A média de dentes perdidos foi 10,3 (EP=2,9). Conforme a classificação de perdas dentárias, 28,3% não perdeu dentes, 4,9% perderam 1 a 4 primeiros molares, 18,2 % perderam até 12 dentes posteriores, 25,1% perderam até 12 dentes, incluindo um ou mais anteriores, 18,2% perderam de 13 a 31 dentes, e 5,3%, eram desdentados. A idade foi associada às categorias das perdas dentárias. Perdas até 12 dentes posteriores apresentaram associação com classe social baixa (RP=2,6; IC95%=1,2-5,2); perdas até 12 dentes, incluindo anteriores, com ter bolsa periodontal> 4mm (RP=2,9, IC95%=1,1-7,5); perda >13 dentes, com classe social baixa (RP=3,8, IC95%=1,3-11,4); e procurar dentista por emergência (RP=9,4, IC95%=3,0-28,9). Conclusão: A utilização dos índices de mortalidade dentária foi importante para ampliar a avaliação das perdas dentárias. O impacto da perda dentária na qualidade de vida aumentou de acordo com o número de dentes perdidos e a posição que ocupam na arcada dentária. A classificação da perda dentária diferenciou indicadores de risco de cada condição, a idade e classe social foram comuns às categorias / Abstract: Aim: This research was evaluated the impact of tooth loss on quality of life among adults using tooth mortality indexes and verified associated factors. Methods: This cross-sectional study evaluated caries (DMFT), periodontal disease and dental biofilm (DB) and demographic, socioeconomic, dental care utilization, self-perception and oral health-related quality of life (OHIP-14) data. For chapter 1, we used data from 386 workers 20-64 years old in a company, São Paulo. The tooth mortality index (TMI) was calculated (M/DMF) and a modified index (TMI mod). The outcome was the upper quartile of each index. We performed Poisson Regression. For chapters 2 and 3, 248 (20-64 year-old) residents in Piracicaba-SP, Brazil, through a household probability sample were examined. Position and number of missing teeth, were both considered to evaluate the impact of tooth loss on quality of life. OHIP severity (total score) and OHIP prevalence were outcomes of chapter 2. Tooth loss classification was the outcome for chapter 3. Data analyses were performed through binary logistic regression, negative binomial regression and for multinomial logistic regression. A hierarchical approach was adopted using a conceptual model. Results: The upper quartile for TMI was 50% and 44% for the TMI mod. Being older and visible DB was associated with tooth mortality. Lower family income (PR=1.6, 95%CI=1.0-2.5), and not flossing (PR=1.7, 95%CI=1.1- 2.6) were associated with TMI, and low education (PR=1.6, 95%CI=1.0- 2.4) and seek the dentist motivated by pain (PR=1.8, 95%CI=1.1-3.0) at the TMI mod. OHIP mean was 10.21 (SE=1.16), 48.1% (n=115) reporting one/more impacts fairly/very often. It were associated with OHIP severity those who had lost up to 12 teeth, including anterior teeth (PRR=1.63, 95%CI=1.06-2.51), 13-31 missing teeth (PRR=2.33, 95%CI=1.49-3.63), and the edentulous (PRR=2.66, 95%CI=1.55-4.57), and also for seeking dental care because of pain or dental needs and having caries. For OHIP prevalence: using dental services due to pain, having caries and having low income. The mean number of missing teeth was 10.3 (SE=2.9) and the distribution, according to the tooth loss classification, was 28.3% for those without tooth loss, 4.9% missing 1-4 first molars, 18.2% missing up to 12 posterior teeth, 25.1% missing up to 12 teeth, including anterior(s), 18.2% 13-31 teeth, and 5.3% being edentulous. Age was significant for all categories of tooth loss. Those who had missed up to 12 posterior teeth presented significant PRs for low social class (PR=2.6, 95%CI=1.2-5.2). Who missed up to 12 teeth including anterior, the risk indicators were clinical attachment loss>4mm (PR=2.9, 95%CI=1.1-7.5); for tooth loss >13 teeth, low social class (PR=3.8, 95%CI=1.3-11.4), and visiting a dentist due to emergency (PR=9.4, 95%CI=3.0-28.9). Conclusion: The tooth mortality index utilization was important to evaluate a wider tooth loss. The impact of tooth loss on oral health-related quality of life gradients was consistent with the number and position of missing teeth. The tooth loss classification allowed to differentiating the risk indicators of each condition, age and social class were common to categories / Doutorado / Saude Coletiva / Doutora em Odontologia

Orientador: Maria da Luz Rosário de Sousa / Dissertação (mestrado profissional) - Universidade Estadual de Campinas, Faculdade de Odontologia de Piracicaba. / Made available in DSpace on 2018-08-18T20:49:34Z (GMT). No. of bitstreams: 1 Silva_EdnaAlves_M.pdf: 1125594 bytes, checksum: fbfc3159a7539fe4de0a7293c6ad454d (MD5) Previous issue date: 2011 / Resumo: Os objetivos deste estudo foram conhecer as condições de saúde bucal dos adultos usuários do Sistema Único de Saúde - SUS, verificar a associação da perda dentária na qualidade de vida e verificar se alta experiência de cárie interfere na qualidade de vida da população estudada. Este estudo transversal foi realizado com 111 adultos de 30 a 59 anos, em duas Unidades Básicas de Saúde da cidade de São Paulo. O exame clínico foi realizado por um examinador para avaliar as condições da cárie dentária, seguindo os critérios da Organização Mundial da Saúde. Foram aplicados questionários para obter dados socioeconômicos, demográficos, comportamentais. Para avaliar qualidade de vida na saúde bucal foi aplicado o instrumento Oral Health Impact Profile (OHIP-14). Utilizaram-se, para perda dentária, os dentes perdidos (limite 7 dentes perdidos) e para o grupo de alta experiência de cárie o SiC - Significant Index Caries (limite 25,5), e na avaliação da qualidade de vida o OHIP-14 foi dicotomizado em ter presença e ausência de impacto. Foi realizada uma análise descritiva e utilizado o teste do qui-quadrado, com o nível de significância de 5%. A média de idade foi 42 anos. O CPOD foi de 18,55 (+6,7), sendo a média de dentes cariados 1,6 (+1,8), perdidos de 8,6 (+6,5), e obturados 8,2 (+5,1). A perda dentária foi associada com a limitação funcional (p=0,013), desconforto psicológico (p=0,017), incapacidade física (p=0,002) e incapacidade social (p=0,036). O grupo de alta experiência de cárie foi associado com incapacidade física (p=0,004) e limitação física (p=0,025). A utilização do indicador subjetivo OHIP-14 mostrou que a incapacidade física foi associada tanto à perda dentária como ao grupo de alta prevalência de cárie, sendo importante instrumento para medir o impacto da saúde bucal na qualidade de vida / Abstract: The objectives of this study were to understand the conditions of oral health status of adults users from the Unified Health System - UHS, to verify the association between tooth loss and the impact on quality of life and see if the high caries experience interferes in the quality of life of this population. A survey was conducted with 111 adults from 30 to 59 years in two Basic Health Units in São Paulo. The clinical examination was conducted by an examiner to assess the conditions of dental caries, following the criteria of World Health Organization. Questionnaires were used to obtain demographic, socioeconomic and behavioral factors. To asses quality of life in oral health was applied Oral Health Impact Profile (OHIP-14) instrument. It was used to tooth loss, a limit of 7 missing teeth, and the group of high caries experience, SiC - Significant Caries Index (limit 25.5), and assessing the quality of life the OHIP-14 it was dichotomized into have presence and absence of impact. It was performed a descriptive analysis and used the chi-square rejection level of 5%. The mean age was 42 years. The DMFT was 18.55 (+6.7), with an average of 1.6 decayed teeth (+1.8), missed 8.6 (+6.5), and filled 8.2 (+5.1). Tooth loss was associated with functional impairment (p=0.013), psychological distress (p=0.017), physical disability (p=0.002) and disability social (p= 0.036). The group of high caries experience was associated with physical disability (p=0.004) and physical impairment (p=0.025). The use of subjective indicator OHIP-14 showed that physical impairment was associated with both tooth loss as the group of high caries experience, an important tool to measure the impact of oral health on quality of life / Mestrado / Odontologia em Saude Coletiva / Mestre em Odontologia em Saúde Coletiva

In 1982/83, the author, in the role of consultant to the firm of Thompson Berwick Pratt and Partners, Architects and Planners, Vancouver, conducted a regional health needs study In the interior of British Columbia for the Board of the Thompson-Nicola Regional Hospital District (TNRHD). The completed report entitled, The Thompson-Nicola Regional Hospital District Health and Hospital Study has subsequently been tabled as a public document. This planning thesis is concerned with the processes of conducting the study which was more complex than originally envisaged. The narrative describes the planning model developed by the consultants to fit the terms of reference which were, in brief, to assess existing local health service needs and the supply and distribution of health resources in the region, and to project future requirements through 1991. In attempting to develop the model it was realized that the Thompson-Nicola Regional Hospital Board had limited powers to initiate a study for all health and hospital providers in the region. The Board's planning mandate was limited by statute, and this limitation is explored. Co-operation among local providers was achieved through persuasion. The Ministry of Health (MOH) had funded 60 per cent of the project, thereby indicating to local groups that it supported the Board's planning approach. The Ministry of Health's concern for rational planning has already been expressed in other ways (e.g. The British Columbia Hospital Role and Funding Studies) although planning is still ad hoc rather than part of a clear Ministry policy. The lack of integration among providers made it difficult to determine need and demand for health services in the region. There were specific problems of definition of need, and specific and recurrent problems of data collection and analysis because of the large number of independent data resource groups involved. Problems in selecting and applying models of analysis were also experienced. Nevertheless, a model of health services needs and resource requirements was constructed. / Medicine, Faculty of / Population and Public Health (SPPH), School of / Graduate

Primary prevention in health care services has effected important economies through prevention of handicap in children and through the reduction of financial and time costs for expensive, often life-time care. An important recent development in education has been the application of the concept to the innovation of preventive practices. These emphasize the promotion of competencies and strengths in children, particularly during critical periods in development, rather than the treatment of emotional, behavioral and learning deficits. This research investigated the immediate effects of a preventive programme, a modification of the Bessell and Palomares Methods in Human Development (MHDP), upon the learning of competencies and coping skills associated with cognitive and ego development in kindergarten and first grade children. The literature suggested a critical period at this point in ego development. Using a sample of 103 metropolitan kindergarten and first grade children, the effects of the Bessell and Palomares programme were compared to the effects of another discussion group method, Show-and-Tell. A fully-crossed fixed-effects three-factor design was used to test eight hypotheses; treatment main effects, sex and grade-level effects and all possible interactions. The dependent variables selected as representative of cognitive and ego development were: cognitive performance competency as measured by (1) minutes spent in mature problem-solving behavior on the Keister Puzzle Box and (2) school achievement (for first grade pupils only); social competency as measured by scores received on measures of (1) teacher perception of dysfunctional behavior, (2) peer perception of observed socially positive or neutral behavior, and (3) peer affiliation; affective competency as measured by scores received on measures of (1) the child's predominant emotional response to life and (2) the child's feelings of independent security (for first grade pupils only). Results pertaining to hypotheses were: 1. A significant multivariate F revealed differences between the two treatments. These differences were accounted for by changes in two of the social competency measures, the teacher behavior rating and the peer perception measure. For both measures the students taught under the modified Methods in Human Development programme (MHDP) gained significantly more than those taught under Show-and-Tell (SAT). 2. A significant interaction was found between treatment and grade-level, with followup univariate analyses showing a significant F for the measure of teacher perception of dysfunction. For kindergarten students taught under MHDP there was a greater reduction than for students taught under SAT. There was no statistical difference for first grade pupils. 3. Informal results were also presented which gave additional support to the effectiveness of the MHDP programme, particularly at the kindergarten level. 4. All other null hypotheses were accepted. A discussion of results included the following points: 1. In spite of the relatively brief, treatment period (18 weeks), the substantive impact of the treatment upon overt social functioning was noteworthy. Such positive functioning had been identified in the literature as predictive of adult competence. 2. While the peer affiliation measure was not significant, some informal results suggested a modest increase in social effectiveness for the Bessell and Palomares participants. 3. Possible weaknesses in instrumentation and the programme omissions necessitated by time restrictions may have contributed to the lack of clear results, particularly for first grade students. 4. Informal results from the standardized problem-solving situation seemed promising in providing valuable information on the behavioral or temperamental and cognitive styles of children. It was conjectured that such observational data would be helpful in educational planning for young children. Suggestions were made for further research particularly with the full grade one programme and on the use of the problem-solving device. / Education, Faculty of / Graduate

Orientadores: José Flávio Affonso de Almeida, Maria Cristina Volpato / Tese (doutorado) - Universidade Estadual de Campinas, Faculdade de Odontologia de Piracicaba / Made available in DSpace on 2018-08-26T12:40:12Z (GMT). No. of bitstreams: 1 Monteiro_MariaRachelFigueiredoPenalva_D.pdf: 1322960 bytes, checksum: b5d4e7c22088eace3d2a9b911ec4a172 (MD5) Previous issue date: 2015 / Resumo: A dor de origem dental é caracterizada como uma dor aguda e está intimamente relacionada com a necessidade da administração de fármacos para alívio do sintoma, na tentativa de retardar a procura por atendimento odontológico. Nesse contexto, o uso de fármacos ocorre, muitas vezes, sem diagnóstico, prescrição ou orientação feitos pelo dentista. Desta forma, este trabalho teve por objetivo avaliar a prática da automedicação com a dor odontogênica, em pacientes que procuram o serviço universitário para atendimento odontológico. Este levantamento foi composto de 486 pacientes que se apresentaram ao Plantão de Urgências da Faculdade de Odontologia de Piracicaba FOP-UNICAMP entre os períodos de Fevereiro de 2012 a Julho de 2013. Os pacientes foram submetidos à anamnese e, foram obtidas informação sobre: o perfil da amostra como idade e gênero, as características da dor como a intensidade e duração até a procura por atendimento, características da medicação administrada para controle da dor como o classe do medicamento e sua eficácia, o tempo de uso da medicação até a procura por atendimento e o tipo de prescrição- automedicação ou prescrito, além do motivo para demora na procura por atendimento. A análise estatística foi feita através dos testes de Qui-Quadrado para avaliar o perfil da amostra: gênero, idade, intensidade e tempo de dor, tipo de prescrição, classe da medicação e tempo de uso, efetividade do medicamento e motivo da demora na procura pelo atendimento, Mann-Whitney na análise da idade e tempo de dor em relação ao gênero e Kruskal-Wallis para avaliar o tempo de dor e medicação em função da intensidade de dor. Houve maior prevalência de procura pelo serviço por adultos entre 25-50 anos (62,8%) e de mulheres (68,3%, p<0,001). Foi observado que, 31,7% apresentou dor moderada e 66,5% severa, onde 54,7% dos entrevistados fizeram uso da automedicação. A medicação mais utilizada foi a dipirona sódica (50%), seguida do paracetamol (20,4%) e diclofenaco (15,6%). Em relação ao uso de antibióticos a incidência em geral foi baixa (13,2%), a classe dos beta-lactâmicos foi a mais consumida (amoxicilina, 11,7%) e o uso de antimicrobianos foi pouco eficaz no controle da dor de origem dental (p=0,0041). Foi observado que, 108 pacientes fizeram uso de algum tipo de associação entre as medicações prescritas ou não. A maioria dos pacientes esperaram até uma semana para procurar atendimento (51,4%) e a medicação usada aliviou parcialmente a dor (53,3%). Não houve diferença estatística significante para o motivo da demora na procura de atendimento (p=0,23). Através deste levantamento foi possível concluir que: houve maior procura pelo tratamento por adultos do gênero feminino; pacientes com dor de origem dental procuram o atendimento cerca de uma semana após o primeiro episódio de dor e relatam, na sua maioria, uma intensidade de dor moderada a severa, onde o controle unicamente medicamentoso foi ineficaz para sanar o problema; a prática da automedicação é corriqueira; a medicação mais consumida pertence ao grupo dos analgésicos com destaque para a dipirona e; não houve uma motivação específica para a demora na procura por atendimento na faculdade / Abstract: Dental pain is characterized as an acute pain and is commonly associated with the use of medication to relieve this symptom, in an attempt to delay dental care search. In this context, the use of drugs often occurs without diagnosis, prescription nor orientation made by the dentist. Thus, this study aimed to assess the influence of selfmedication in patients with odontogenic pain that sought an university dental service. This survey was composed of 486 patients who presented to the Emergency of the University of Dentistry of Piracicaba FOP-UNICAMP between the periods of February 2012 to July 2013. Patients underwent anamnesis and were obtained information about: personal details (age and gender), intensity and duration of pain, selfmedication, duration (days) and class of drug used and motive to the delay in seeking dental care. Statistical analysis was performed using the chi-square test to analyze gender, age, level of pain, duration of pain, self-medication, medication class, effectiveness of medication and reason for the delay in seeking care; Mann-Whitney to evaluate age, duration of pain in relation to gender and Kruskal-Wallis to analyze time and pain medication in relation to pain intensity. There was a higher prevalence among adults between 25-50 years (62.8%) and women (68.3%, p <0,001). It was observed that patients presenting dental pain 31.7% moderate and 66.5% severe intensity and 54.7% made use of self-medication. Most patients waited until one week to seek treatment (51.4%) and overall the medication used relieved pain partially (53.3%). The most used medication was dipyrone (50%), followed by acetaminophen (20.4%) and diclofenac (15.6%). Regarding the use of antibiotics, for dental pain control, the incidence was low (13.2%) with a tendency to ineffective (p = 0.0009) and the class of beta-lactams was the most consumed (amoxicillin 11.3%). It was observed that 108 patients made some type of association with medication prescribed or not. No significant difference was found for the reason of delay in seeking care (p = 0.023). It is concluded that: women seek dental treatment more often than men; patients with dental pain seek dental care after one week from the first pain episode which was clammed to have moderate to severe intensity; pain control was usually done by self-medication which shows no sufficient efficacy; the class of drugs most used was the analgesic group (dipyrone) and there was no specific reason for the delay in seeking care / Doutorado / Endodontia / Doutora em Clínica Odontológica

El texto completo de este trabajo no está disponible en el Repositorio Académico UPC por restricciones de la casa editorial donde ha sido publicado. / Purpose: This study analyzes the factors associated with eye care service utilization among Peruvians 50 years of age and older, measured as self-reporting of having undergone examination of visual acuity during the last 12 months. Methods: A secondary analysis of the 2019 Demographic and Family Health Survey (ENDES, for its acronym in Spanish) database was carried out. We estimated the weighted proportion of adults 50 years of age and older that reported having undergone a visual acuity examination in the previous 12 months and the frequency according to the variables of interest. Crude (PR) and adjusted prevalence ratios (aPR) of eye care service utilization were constructed using generalized linear models. Results: Approximately 28.8% of Peruvians 50 years of age and older underwent a visual acuity examination in the previous 12 months. Having a higher education (aPR = 1.79; 95% CI: 1.33–2.40), health insurance such as EsSalud (aPR = 1.54; 95% CI: 1.28–1.87), a previous diagnosis of cataracts (aPR = 1.86; 95% CI: 1.67–2.09) and being part of the richest wealth quintile (aPR = 2.36; 95% CI: 1.74–3.20) were associated with greater utilization of eye care services, while living in the jungle was associated with a lower likelihood of utilization of these services. Conclusion: The unequal distribution of health resources within the territory and socioeconomic gaps among the population could explain our findings. Further efforts are needed to fulfill the eye health needs of the Peruvian population.

Thesis (M.S.)--University of Michigan, 1981.

Thesis (M.S.)--University of Michigan, 1981.