Susana Zelaya

Introduction. In El Salvador, there was a need to establish indicators that could provide an overview of the population’s mental health status. In response, the National Institute of Health led the implementation of the first National Mental Health Survey, becoming a pioneering effort in interinstitutional collaboration. This article documents the full scope of the first National Mental Health Survey experience, from its conception and methodological and operational design to fieldwork execution and the lessons learned throughout the process. Results. A total of 6837 households participated, yielding a response rate of 82.9%. Response rates varied across age groups and by sex: adolescents (63.5 %) and older adults (64.0 %) demonstrated lower levels of participation, as did adult men. These disparities posed challenges to representativeness and raise important considerations regarding potential barriers to participation. The implementation strategy integrated digital data collection tools, intensive training of field personnel, and close collaboration with local communities and institutions, which helped to overcome logistical barriers and foster trust at the community level. Conclusion. The first National Mental Health Survey establishes a robust baseline of mental health indicators to inform public policy and program development. The experience demonstrates that high-quality data can be produced in resource-limited settings through technical leadership, strategic partnerships, and strong institutional commitment, offering a replicable model for national mental health surveillance in similar contexts.

Mental health has been a relevant topic since 1940, however, its explicit visibility as a right began in the year 2000, when states were invited to recognize it as part of the right to health. Following this awareness-raising process, the Central American countries have developed public policies, based on their legislatures, for the creation of laws, regulations, plans and mental health policies. Currently, there is no analysis that describes the main historical events, legal framework and public policy on mental health as a right in Central America. The objective of the review is to identify main historical milestones, the current status and the challenges that persist in the region to strengthen the approach to mental health as a fundamental right of the populations. Search strategy, websites of Ministries of Health, Central American justice bodies, and Google Scholar and Google database, from 1949 to 2023. The construction of public policies on mental health in Central American countries presents advances, setbacks or stagnation according to their national context. There is still a poor political disposition in various Central American countries to promote a Mental Health Law or update existing mental health laws and documents.

Introduction. Breast milk is the ideal food for newborns, providing all the energy and nutrients a child needs in the first months of life. Objective. Determine the sociodemographic and gynecological-obstetric factors that promoted exclusive breastfeeding before six months of age in children with mothers aged 15 to 49 in El Salvador during 2021. Methodology. Analytical cross-sectional study of the 2021 National Health Survey of El Salvador. Children aged zero to five months were included. Descriptive and bivariate analytical statistics were applied for the analysis. Results. Of the 344 participants aged zero to five months, only 69.8 % were exclusively breastfed, 2.1 % received care during childbirth in private centers, 33.7 % did not have early attachment, and 9.2 % had a very high wealth index. Conclusion. The factors that were beneficial for exclusive breastfeeding were living in a rural area, receiving medical attention during delivery, and initiating breastfeeding within one hour of birth. The study population did not benefit from exclusive breastfeeding because they received delivery care in a private center, did not achieve early attachment, and had a very high wealth index.

COVID-19, caused by the SARS-CoV-2 virus, is a highly pathogenic emerging infectious disease. Healthcare personnel (HCP) are presumably at higher risk of acquiring emerging infections because of occupational exposure. The prevalence of COVID-19 in HCP is unknown, particularly in low- to middle-income countries like El Salvador. The goal of this study was to determine the seroprevalence of anti-SARS-CoV-2 antibodies among HCP in El Salvador just prior to vaccine rollout in March 2021. We evaluated 2176 participants from a nationally representative sample of national healthcare institutions. We found 40.4% (n = 880) of the study participants were seropositive for anti-spike protein antibodies. Significant factors associated with infection included younger age; living within the central, more populated zone of the country; living in a larger household (≥7 members); household members with COVID-19 or compatible symptoms; and those who worked in auxiliary services (i.e., housekeeping and food services). These findings provide insight into opportunities to mitigate SARS-CoV-2 risk and other emerging respiratory pathogens in HCP in El Salvador.

Purpose: The effectiveness of coronavirus disease 2019 (COVID-19) vaccination schemes and the combination of vaccines of various platforms for administering booster doses is still being studied since it will depend on the population's response to vaccines. We aimed to evaluate the safety, protection, and immunogenicity of the Salvadorean population's third dose booster COVID-19 vaccine and the potential benefit of homologous vs. heterologous regimens. Materials and Methods: This is an analytical observational cohort study in a population aged 18 to 65 years that was primarily vaccinated with AstraZeneca, Sinovac, or Pfizer/BioNTech. Volunteers were recruited (n= 223) and followed up for 3 months after receiving the 3rd vaccine (BNT162b2) as a booster. Adverse reactions were monitored, serum anti-spike immunoglobulin G (IgG) was assessed by chemiluminescence, and a polymerase chain reaction was carried out when subjects developed clinical signs. Results: The cohorts finally included 199 participants, and we observed only mild adverse effects in all cohorts. A significant increase in specific IgG levels was found after the booster dose in all cohorts. The heterologous scheme with Sinovac showed the greatest increase in antibody titer, and a decrease was observed in all participants after 3 months. During the follow-up period, 30 participants showed symptomatology compatible with COVID-19, but only four were laboratory-confirmed and they showed mild clinical signs. Conclusion: These findings indicate that the booster doses used were safe and promoted an immediate increase in immunogenicity, which decreased over time. The heterologous regimen showed stronger immunogenicity compared to the messenger RNA-based homologous scheme.