Approbation, mise en marché et surveillance après mise en marché des dispositifs médicaux à risque élevé : examen des enjeux socio-éthiques

La littérature abordant les enjeux socio-éthiques et réglementaires associés aux médicaments est relativement abondante, ce qui n’est pas le cas des dispositifs médicaux (DM). Ce dernier secteur couvre une très large diversité de produits qui servent à de multiples applications: diagnostic, traitement, gestion des symptômes de certaines conditions physiques ou psychiatriques, restauration d’une fonction débilitante, chirurgie, etc. À tort, on a tendance à croire que les DM sont réglementés de la même manière que les médicaments, que ce soit pour les exigences concernant leur mise en marché ou des pratiques de surveillance après mise en marché. Or, au cours des dernières années, leur usage élargi, leur impact sur les coûts des soins de santé, et les rappels majeurs dont certains ont fait l’objet ont commencé à inquiéter la communauté médicale et de nombreux chercheurs. Ils interpellent les autorités réglementaires à exercer une plus grande vigilance tant au niveau de l’évaluation des nouveaux DM à risque élevé avant leur mise en marché, que dans les pratiques de surveillance après mise en marché. Une stratégie plus rigoureuse d’évaluation des nouveaux DM permettrait d’assurer un meilleur suivi des risques associés à leur utilisation, de saisir la portée des divers enjeux socio-éthiques découlant de l’utilisation de certains DM, et de préserver la confiance du public. D’emblée, il faut savoir que les autorités nationales n’ont pas pour mandat d’évaluer la portée des enjeux socio-éthiques, ou encore les coûts des DM qui font l’objet d’une demande de mise en marché. Cette évaluation est essentiellement basée sur une analyse des rapports risques-bénéfices générés par l’usage du DM pour une indication donnée. L’évaluation des impacts socio-éthiques et l’analyse coûts-bénéfices relèvent des agences d’Évaluation des technologies de santé (ÉTS). Notre recherche montre que les DM sont non seulement peu fréquemment évalués par les agences d’ÉTS, mais l’examen des enjeux socio-éthiques est trop souvent encore incomplet. En fait, les recommandations des rapports d’ÉTS sont surtout fondées sur une analyse coûts-bénéfices. Or, le secteur des DM à risque élevé est particulièrement problématique. Plusieurs sont non seulement porteurs de risques pour les patients, mais leur utilisation élargie comporte des impacts importants pour les systèmes de santé. Nous croyons que le Principisme, au cœur de l’éthique biomédicale, que ce soit au plan de l’éthique de la recherche que de l’éthique clinique, constitue un outil pour faciliter la reconnaissance et l’examen, particulièrement par les agences d’ÉTS, des enjeux socio-éthiques en jeu au niveau des DM à risque élevé. Également, le Principe de Précaution pourrait aussi servir d’outil, particulièrement au sein des agences nationales de réglementation, pour mieux cerner, reconnaître, analyser et gérer les risques associés à l’évaluation et l’utilisation de ce type de DM. Le Principisme et le Principe de Précaution pourraient servir de repères 1) pour définir les mesures nécessaires pour éliminer les lacunes observées dans pratiques associées aux processus de réglementation, et 2) pour mieux cerner et documenter les enjeux socio-éthiques spécifiques aux DM à risque élevé.

Early adversity, brain development and emotion processing in monozygotic twins

Il existe actuellement de nombreuses preuves démontrant que des facteurs génétiques et environnementaux interagissent pendant des périodes spécifiques du développement pour rendre une personne vulnérable aux troubles psychologiques via diverses adaptations physiologiques. Cette thèse porte sur l'impact de l’adversité prénatale (représentée par le petit poids à la naissance, PPN) et de l’adversité postnatale précoce (symptômes dépressifs maternels et comportements maternels négatifs), sur le développement du cerveau, particulièrement les régions fronto-limbiques impliquées dans le traitement des émotions, pendant l'enfance et l'adolescence. Des jumeaux monozygotes (MZ) sont utilisés, lorsque possible, afin de contrôler pour les effets génétiques. Les chapitres 1 et 2 présentent les résultats de la vérification de l'hypothèse que l’adversité prénatale et postnatale précoce sont associées à une altération du fonctionnement des régions fronto-limbique tels que l’amygdale, l’hippocampe, l’insula, le cortex cingulaire antérieur et le cortex préfrontal, en réponse à des stimuli émotifs chez des enfants et des adolescents. On observe que les symptômes dépressifs maternels sont associés à une activation plus élevée des régions fronto-limbiques des enfants en réponse à la tristesse. Les résultats de l’étude avec des adolescents suggèrent que le PPN, les symptômes dépressifs et les comportements maternels négatifs sont associés à une fonction altérée des régions fronto-limbiques en réponse à des stimuli émotionnels. Chez les jumeaux MZ on observe également que la discordance intra-paire de PPN et de certains comportements maternels est associée à une discordance intra-paire du fonctionnement du cerveau et que ces altérations diffèrent selon le sexe. Le chapitre 3 présente les résultats de la vérification de l'hypothèse que l’adversité prénatale et postnatale précoce sont associées à un volume total réduit du cerveau et de l’hypothèse que les comportements maternels peuvent servir de médiateur ou de modérateur de l'association entre le PPN et le volume du cerveau. Avec des jumeaux MZ à l’adolescence on observe a) que le PPN est effectivement associé à une diminution du volume total du cerveau et b) que la discordance intra-paire de PPN est associée à une discordance du volume du cerveau. En somme, cette thèse présente un ensemble de résultats qui soutiennent deux hypothèses importantes pour comprendre les effets de l’environnement sur le développement du cerveau : que l’environnement prénatal et postnatal précoce ont un impact sur le développement du cerveau indépendamment du code génétique et que les mécanismes impliqués peuvent différer entre les garçons et les filles. Finalement, l’ensemble de ces résultats sont discutés à la lumière des autres travaux de recherche dans ce domaine et des avenues à explorer pour de la recherche ultérieure sont proposées.

Narrative development and supported employment of persons with severe mental illness

Essai présenté à la Faculté des arts et des sciences en vue de l’obtention du grade de Doctorat en psychologie option psychologie clinique

Description de l’évolution du profil socio-cognitif et clinique d’une cohorte d’adolescents diabétiques de type 1 ayant suivi un programme d’éducation thérapeutique

Thèse réalisée en cotutelle entre Aix-Marseille Université et l'Université de Montréal

Integrated Management for Sustainable Development of Coastal Zones – A Gis Based Study on the Central Kerala Coast

The present study focuses on the stability of the coast, exploitation of the coastal resources, human activities within the study are that extends from Fort Cochin at north to Thottappally at south, central Kerala State and hinterlands, socio-economic problems of the coastal community and the environmental issues arising in the recent past due to human activities. The objective of the study is critically analyse the coastal zone region and prevailing situation and to propose a comprehensive management plan for the sustainable development of the region under study. The thesis covers varied aspects of coastal uses like fisheries, tourism, land use, water resources etc. To critically examine the above scenarios, the ILWIS (Integrated Land and Water Information Systems) – GIS software has been used. A satellite image of the area has been used for the coastline change detection and land use patterns. The outcome of the present study will be beneficial to the various stakeholders within the coastal region and its hinterlands. To further add, this study should find better applications to similar or near-similar situations of Southeast Asia where identical scenarios are noticeable.

Dynamics of Deforestation and Socio-Economic profile of Tribal Women Folk in Kerala- A study of Attappady is

This thesis Entitled Dynamics of deforestation and Socio-Economic profile of tribal women flok in kerala -A study of Attappady. The study was based on both primary and secondary data. Primary data were collected through a sample survey conducted in three panchayaths .The thesis is organized in eight chapters. The first chapter provides the background to the study. Second chapter reviews the literature. Third chapter provides the profile of the study area and general conditions. Fourth chapter consists of the life cycle structure of the tribal woman. Fifth chapter covers the socio-economic conditions of the tribal women in the study area. Sixth chapter consists of relationship between tribal women and forest and the degradation of the forest. Seventh chapter provides the documentation of the development programmes implemented in Attappady and their importance to the tribals. Last chapter consists of summary and conclusions of the study, suggestions and recommendations of the study.

Socio-Economic Survey of a Specific village

This thesis Entitled Socio-Economic Survey of a Specific village.For the purpose of analysis the thesis is divided into nine chapters. The first chapter introduces the subject of study and explains the significance of the study.It also provides the profile of the village. Chapter two deals with the different aspects of agriculture in the village.Chapter three discusses the problems of industrialisation in the Village. Chapter four is on village administration. It elaborates on the services rendered by government machinery in facilitating the development of agriculture and industry in the village.Chapter five explains the ways and means of marketing of village produce, both industrial and agricultural origin. It also explains the relevance of intra village connections in facilitating marketing.Chapter seven provides information regarding the income and expenditure pattern of the village.Chapter eight is on village social life. It explains the social life of the villagers, including religious

Level Of Women Participation In Rural Development - A Comparative Study Of Governmental And Non-Governmental Organisations In Kerala

The study is intended to estimate the existing rate of participation of women beneficiaries in the development programmes of different organisations in Kerala. It would enable one to understand whether participation is at the satisfactory level or not. Given the rate of participation, the major thrust of the analysis is on the impact of governmental and non-governmental organisations on the rate of participation. This is undertaken under the assumption that NGOs, due to their proximity to people and their needs, ensure better participation rates. Besides the organisational differences, the other major determinants of women participation such as their socio-economic characteristics, psychological make up, the nature of the programme etc. are also highlighted. 0 Since the ascribed status of women in society is inferior, the role of organisers, development personnel and local leaders is also pointed out. Thus the basic objective of the study is women participation and its determinants in the development programmes

A socio friendly approach to the analysis of emotive speech

This paper describes certain findings of intonation and intensity study of emotive speech with the minimal use of signal processing algorithms. This study was based on six basic emotions and the neutral, elicited from 1660 English utterances obtained from the speech recordings of six Indian women. The correctness of the emotional content was verified through perceptual listening tests. Marked similarity was noted among pitch contours of like-worded, positive valence emotions, though no such similarity was observed among the four negative valence emotional expressions. The intensity patterns were also studied. The results of the study were validated using arbitrary television recordings for four emotions. The findings are useful to technical researchers, social psychologists and to the common man interested in the dynamics of vocal expression of emotions

Community Participation in Ecotourism: An Inclusive Development Option for Kerala

The inferences obtained from the study are presented in coherent area-specific levels so as to understand the ecotourism and its sub-sector areas for the researchers and policy makers about the issues, importances and potentialities of the sector. An analysis of the tourism sector in Kerala has shown tremendous growth both in terms of tourist arrivals and in terms of revenue generation from direct and indirect sources. The foreign tourist visitors in Kerala in 2014 was 9,23,336 which shows 7.60 percent increase from the last year and the domestic tourist visitors were 1,16,95,411 which again shows 7.71 percent increase, is a clear evidence of its potential. In 2014 the industry contributed revenue of 24885.44 crores from direct and indirect sources giving rise to an increase of 12.11 percent from the last year. A dichotomy of tourists and ecotourists shows that tourists in the ecotourism destinations come to 42.6 percent of the total, shows the scope, significance and its potential. Correlation of zone-wise tourist arrivals based on the ecotourism destinations highlights the fact that with only 19 of the 64 destinations that come in the central zone are the most preferred centres (around 54 percent) for the domestic as well as foreign tourists. The north zone encompassing 6 districts with rich biodiversity shows that the tourists‟ arrival patterns exhibit less promising results. Though the north zone has 31 ecotourism destinations of the state receives only 6.19 percent of the foreign visitors. The ecotourism activities in the state are primarily managed by the Eco-Development Committees (EDCs) and the Vana Samrakshana Samithies (VSS) under the Forest Development Agency of Kerala. Social class-wise categorization of membership shows that 13142 families have membership in 190 EDCs with SC (28 percent), ST (33 percent) and other marginalised communities (39 percent). But this in the VSS shows that 400 VSS have 59085 members actively engaged in ecotourism activities and social category of the VSS makes clear that majority are from the other marginalized fringe households with 62 percent where as the participation of SC is 12 percent and ST is 26 percent. An evaluation of the socio-economic and demographic matrix of the community members involved in ecotourism activities brings out region specific differences. About 75.70 percent of the respondents are males and the rest are females. Majority of the respondents (about 60 percent) are in the age group of 20 to 40 years, followed by the age group of 40-50 (20 percent). The average age of respondents in the three zones is between 35 and 37 years. The majority of the respondents are married, a few are unmarried. Average family size is 4-5 members and differences are identified among zones. Average number of adults per household is 3 and child per household is 2. Majority have an education of 10th class and below i.e. about 60 percent of the sample have only basic school education like primary, secondary and high school (i.e. up to SSLC but not passed) level. About 18 percent are SSLC passed, 10 percent are undergraduates whereas 6 percent constitute respondents having qualification of graduation and above. Majority of the „graduates and above‟ are from south and central zone. Inter-zone differences in educational profile are also identified with lesser number of „graduates and above‟ are identified in the north zone compared to the other two zones. Investigating into the income and livelihood options of the respondents gives insight about the prominence of ecotourism as an employment and livelihood option for the community members, as more than 90 percent of the respondents have cited tourism sector as their main employment option. Most (49.30 percent) of respondents get 100 percent income from tourism related activities, followed by 37.30 percent of community members have income between 75-99 percent from tourism whereas the rest (13 percent) have less than 74 percent of their income from tourism and there exists difference between zones and percentage of income. Financial habit shows that about 49.7 percent hold active bank accounts, 61 percent have savings behaviour and 73.8 percent have indebtedness. Analysis about the ownership of house brings to light that 37 percent of respondents live in their own house followed by 25.7 percent in government funded/provided house and 21 percent in their parent‟s house and 3.5 percent in rented house. About 12 percent of the respondents have other kinds of accommodation facilities such as staff quarters, etc. But in the case of north zone majority i.e. 52 percent primarily depend on the government funded house indicating the effectiveness of government housing programme. Standard of living measured in SLI frameworks shows that majority of the respondents have medium SLI values (42.3 percent); the remaining 47.7 percent have low SLI and 10 percent have high SLI. The community members have been benefitted immensely from forest and its resources. Since the ecotourism destinations are located amidst the wildlife settings, majority of them depend on forest for their livelihood. The information on the tourist‟s demographic characteristics like age, sex, educational qualification and annual income show that the age category of domestic and foreign tourists falls below the age group of less than 35 years (about 65 percent), whereas only 16 percent of tourists are aged above 46 years. The age group below 25 years consists of more international tourists (31.3 percent) compared to the proportion of domestic tourists (12.5 percent). Male-female ratio shows that the males constitute 56 percent of the sample and females with 44 percent. The factors determining the impact of ecotourism programmes in the community was evaluated with the aid of a factor analysis with 12 selected statements. The worries and concerns of the community members about the impact of ecotourism on the environment are well understood from this analysis. It can be drawn that environment protection and the role of ecotourism in improving the income and livelihood options of the local communities is the most important factor concerning the community members.

SHGs and Cooperatives in the Fishing Sector: An Inclusive Development Option for the Fisher folk of Kerala

The Kerala model of development mostly bypassed the fishing community, as the fishers form the main miserable groups with respect to many of the socio-economic and quality of life indicators. Modernization drive in the fishing sector paradoxically turns to marginalization drives as far as the traditional fishers in Kerala are concerned. Subsequent management and resource recuperation drives too seemed to be detrimental to the local fishing community. Though SHGs and cooperatives had helped in overcoming many of the maladies in most of the sectors in Kerala in terms of livelihood and employment in the 1980s, the fishing sector by that time had been moving ahead with mechanization and export euphoria and hence it bypassed the fishing sector. Though it has not helped the fishing sector in the initial stages, but because of necessity, it soon has become a vibrant livelihood and employment force in the coastal economy of Kerala. Initial success made it to link this with the governmental cooperative set up and soon SHGs and Cooperatives become reinforcing forces for the inclusive development of the real fishers.The fisheries sector in Kerala has undergone drastic changes with the advent of globalised economy. The traditional fisher folk are one of the most marginalized communities in the state and are left out of the overall development process mainly due to the marginalization of this community both in the sea and in the market due to modernization and mechanization of the sector. Mechanization opened up the sector a great deal as it began to attract people belonging to non-fishing community as moneylenders, boat owners, employers and middle men which often resulted in conflicts between traditional and mechanized fishermen. These factors, together with resource depletion resulted in the backwardness experienced by the traditional fishermen compared to other communities who were reaping the benefits of the overall development scenario.The studies detailing the activities and achievements of fisher folks via Self Help Groups (SHGs) and the cooperative movement in coastal Kerala are scant. The SHGs through cooperatives have been effective in livelihood security, poverty alleviation and inclusive development of the fisher folk (Rajasenan and Rajeev, 2012). The SHGs have a greater role to play as estimated fall in demand for marine products in international markets, which may result in reduction of employment opportunities in fish processing, peeling, etc. Also, technological advancement has made them unskilled to work in this sector making them outliers in the overall development process resulting in poor quality of physical and social infrastructure. Hence, it is all the more important to derive a strategy and best practice methods for the effective functioning of these SHGs so that the

Socio-economic characterization of integrated cropping systems in urban and peri-urban agriculture of Faisalabad, Pakistan

Faisalabad city is surrounded by agricultural lands, where farmers are growing vegetables, grain crops, and fodder for auto-consumption and local marketing. To study the socioeconomic impact and resource use in these urban and peri-urban agricultural production (UPA) systems, a baseline survey was conducted during 2009–2010. A total of 140 households were selected using a stratified sampling method and interviewed with a structured questionnaire. The results revealed that 96 % of the households rely on agriculture as their main occupation. Thirty percent of the households were owners of the land and the rest cultivated either rented or sharecropped land. Most of the families (70 %) were headed by a member with primary education, and only 10 % of the household head had a secondary school certificate. Irrigationwater was obtained from waste water (37 %), canals (27 %), and mixed alternative sources (36 %). A total of 35 species were cultivated in the UPA systems of which were 65% vegetables, 15% grain and fodder crops, and 5% medicinal plants. Fifty-nine percent of the households cultivated wheat, mostly for auto-consumption. The 51 % of the respondents grew cauliflower (Brassica oleracea L.) and gourds (Cucurbitaceae) in the winter and summer seasons, respectively. Group marketing was uncommon and most of the farmers sold their produce at the farm gate (45 %) and on local markets (43 %). Seeds and fertilizers were available from commission agents and dealers on a credit basis with the obligation to pay by harvested produce. A major problem reported by the UPA farmers of Faisalabad was the scarcity of high quality irrigation water, especially during the hot dry summer months, in addition to lacking adequate quantities of mineral fertilizers and other inputs during sowing time. Half of the respondents estimated their daily income to be less than 1.25 US$ and spent almost half of it on food. Monthly average household income and expenses were 334 and 237 US$, respectively.

Changes of traditional farming systems and their effects on land degradation and socio-economic conditions in the Inle Lake region, Myanmar

At many locations in Myanmar, ongoing changes in land use have negative environmental impacts and threaten natural ecosystems at local, regional and national scales. In particular, the watershed area of Inle Lake in eastern Myanmar is strongly affected by the environmental effects of deforestation and soil erosion caused by agricultural intensification and expansion of agricultural land, which are exacerbated by the increasing population pressure and the growing number of tourists. This thesis, therefore, focuses on land use changes in traditional farming systems and their effects on socio-economic and biophysical factors to improve our understanding of sustainable natural resource management of this wetland ecosystem. The main objectives of this research were to: (1) assess the noticeable land transformations in space and time, (2) identify the typical farming systems as well as the divergent livelihood strategies, and finally, (3) estimate soil erosion risk in the different agro-ecological zones surrounding the Inle Lake watershed area. GIS and remote sensing techniques allowed to identify the dynamic land use and land cover changes (LUCC) during the past 40 years based on historical Corona images (1968) and Landsat images (1989, 2000 and 2009). In this study, 12 land cover classes were identified and a supervised classification was used for the Landsat datasets, whereas a visual interpretation approach was conducted for the Corona images. Within the past 40 years, the main landscape transformation processes were deforestation (- 49%), urbanization (+ 203%), agricultural expansion (+ 34%) with a notably increase of floating gardens (+ 390%), land abandonment (+ 167%), and marshlands losses in wetland area (- 83%) and water bodies (- 16%). The main driving forces of LUCC appeared to be high population growth, urbanization and settlements, a lack of sustainable land use and environmental management policies, wide-spread rural poverty, an open market economy and changes in market prices and access. To identify the diverse livelihood strategies in the Inle Lake watershed area and the diversity of income generating activities, household surveys were conducted (total: 301 households) using a stratified random sampling design in three different agro-ecological zones: floating gardens (FG), lowland cultivation (LL) and upland cultivation (UP). A cluster and discriminant analysis revealed that livelihood strategies and socio-economic situations of local communities differed significantly in the different zones. For all three zones, different livelihood strategies were identified which differed mainly in the amount of on-farm and off-farm income, and the level of income diversification. The gross margin for each household from agricultural production in the floating garden, lowland and upland cultivation was US$ 2108, 892 and 619 ha-1 respectively. Among the typical farming systems in these zones, tomato (Lycopersicon esculentum L.) plantation in the floating gardens yielded the highest net benefits, but caused negative environmental impacts given the overuse of inorganic fertilizers and pesticides. The Revised Universal Soil Loss Equation (RUSLE) and spatial analysis within GIS were applied to estimate soil erosion risk in the different agricultural zones and for the main cropping systems of the study region. The results revealed that the average soil losses in year 1989, 2000 and 2009 amounted to 20, 10 and 26 t ha-1, respectively and barren land along the steep slopes had the highest soil erosion risk with 85% of the total soil losses in the study area. Yearly fluctuations were mainly caused by changes in the amount of annual precipitation and the dynamics of LUCC such as deforestation and agriculture extension with inappropriate land use and unsustainable cropping systems. Among the typical cropping systems, upland rainfed rice (Oryza sativa L.) cultivation had the highest rate of soil erosion (20 t ha-1yr-1) followed by sebesten (Cordia dichotoma) and turmeric (Curcuma longa) plantation in the UP zone. This study indicated that the hotspot region of soil erosion risk were upland mountain areas, especially in the western part of the Inle lake. Soil conservation practices are thus urgently needed to control soil erosion and lake sedimentation and to conserve the wetland ecosystem. Most farmers have not yet implemented soil conservation measures to reduce soil erosion impacts such as land degradation, sedimentation and water pollution in Inle Lake, which is partly due to the low economic development and poverty in the region. Key challenges of agriculture in the hilly landscapes can be summarized as follows: fostering the sustainable land use of farming systems for the maintenance of ecosystem services and functions while improving the social and economic well-being of the population, integrated natural resources management policies and increasing the diversification of income opportunities to reduce pressure on forest and natural resources.

Análisis de los efectos de la cooperación internacional en el desarrollo socio económico de una población. Estudio de caso : el PNUD en Soacha. 2005- 2010

El trabajo de investigación, es un análisis sobre la cooperación que brindó el PNUD (Programa de las Naciones Unidas para el Desarrollo) dentro el municipio de Soacha, Cundinamarca, durante los años 2005 a 2010. Tal análisis está encaminado a demostrar qué tan provechosa fue las ayuda que prestó el PNUD y si gracias a esta ayuda, los beneficiarios pudieron percibir cambios estructurales, que es donde se puede medir si se mejoraron o no los niveles de calidad de vida de la población intervenida. Para tal efecto, se analiza si los proyectos planteados por el PNUD estaban construidos para empoderar a la comunidad con el fin de que se percibiera una mejor calidad de vida en la población intervenida tendiente hacia un mejoramiento en el desarrollo social y económico, y si estos proyectos estaban planeados para una duración de mediano a largo plazo; o si por el contrario tan solo eran proyectos mediáticos, sin causar impactos positivos dentro de la sociedad. El modelo teórico que se utilizó para darle soporte a este estudio de caso es el neoliberalismo institucional y el concepto del poder blando, puesto que explican de una manera clara el comportamiento de los actores involucrados en el proceso de la cooperación.

Determinantes socio-económicas de la desnutrición global infantil en la Localidad de Ciudad Bolívar (Bogotá, Colombia) en el año 2011

La desnutrición infantil y la pobreza se encuentran asociadas y estas a su vez con el progreso de los países. Conocer las determinantes sociales y económicas de la niñez que padece de bajo peso es necesario para crear escenarios propicios para el adecuado desarrollo de la primera infancia y de esta manera contribuir con la superación de la pobreza en el marco de sistemas sanitarios equitativos. Se realiza una descripción de las características socio-económicas y un análisis de posibles asociaciones entre estas y el bajo peso infantil de una muestra de infantes de uno de los sectores de mayor vulnerabilidad y pobreza de Bogotá (Colombia). La tasa del bajo peso infantil en la muestra del estudio en más alta a la presentada en Bogotá y Colombia (8.5%, 2.9% y 3.4% respectivamente). Al realizar el análisis de las posibles asociaciones entre el bajo peso y las variables de estudio, se evidencia que las relaciones son débiles entre la primera y las segundas, siendo la condición de desplazamiento la que mayor asociación positiva presenta con la deficiencia nutricional seguido del rango de edad entre los 25 y 36 meses. La situación que presenta mayor independencia con respecto al bajo peso infantil es contar con vivienda propia seguida del sexo. La desnutrición infantil se presenta en niveles importantes en sectores de mayor vulnerabilidad con implicaciones para el adecuado desarrollo de los infantes y para las intenciones de reducción de los índices de pobreza en el país. El fortalecimiento de las políticas públicas que favorezca el desarrollo infantil, la superación de la pobreza y las inequidades en los sistemas de salud deben contemplar acciones integrales dirigidas a los más vulnerables, con la participación de la sociedad civil y los sectores públicos y privados, el compromiso político y económico de los gobiernos y reglas claras que contribuyan a la solución estructural de la pobreza y que promueva el adecuado desarrollo infantil.