Desigualdades en la mortalidad debidas a la infección respiratoria aguda en niños: análisis de la situación en Colombia

Introduction: Acute respiratory infections (ARI) are a leading public health issue worldwide. Objective: To explore the inequalities in ARI mortality rates in under-5, according to socioeconomic characteristics. Materials and methods: We conducted an ecological analysis to study inequalities at municipal level due to ARI mortality in children under 5 years. The data were obtained from official death records of the Departamento Administrativo Nacional de Estadística. The analysis of inequalities in the under-5 mortality rate (U5MR) included: 1) Classification of the population in different socio-economic strata, and 2) measurement of the degree of inequality. We used the ARI-U5MR as an outcome measurement. The mortality rates were estimated at national and municipal levels for the years 2000, 2005, 2010, and 2013. Rate ratios, rates differences, and concentration curves were calculated to observe the inequalities. Results: A total of 18,012 children under 5 years died by ARI in Colombia from 2000 to 2013. ARIU5MR was greater in boys than in girls. During this period, an increase in the infant mortality relative gap in both boys and girls was observed. In 2013, the U5MR evidenced that for boys from municipalities with the highest poverty had a 1.6-fold risk to die than those in municipalities with the lowest poverty (low tercile). In girls, the ARI-U5MR for 2005 and 2013 in the poorest tercile was 1.5 and 2 times greater than in the first tercile, respectively. Conclusion: Colombian inequalities in the ARI mortality rate among the poorest municipalities compared to the richest ones continue to be a major challenge in public health.Introducción. Las infecciones respiratorias agudas (IRA) son un importante problema de salud pública a nivel mundial. Objetivo. Explorar las desigualdades de la tasa de mortalidad debida a IRA en niños menores de 5 años según las variables socioeconómicas. Materiales y métodos. Se hizo un análisis ecológico para estudiar las desigualdades a nivel municipal de las tasas de mortalidad por IRA en menores de 5 años. Los datos se obtuvieron a partir de los registros de muertes del Departamento Administrativo Nacional de Estadística. El análisis de desigualdades incluyó la clasificación de la población por estatus socioeconómico y la medición del grado de desigualdad. Como resultado en salud se utilizó la tasa de mortalidad por IRA en menores de 5 años. Se estimaron tasas a nivel nacional y municipal para 2000, 2005, 2010 y 2013. Se calcularon razones y diferencias de tasas y curvas de concentración para observar las desigualdades. Resultados. Entre 2000 y 2013 murieron por IRA en Colombia 18.012 menores de 5 años. La tasa de mortalidad por ARI fue mayor en niños que en niñas. En el periodo, se observó un incremento en la brecha de mortalidad infantil en ambos sexos. En el 2013, la tasa de niños que murieron en municipios con mayor pobreza fue 1,6 veces mayor que la de niños en aquellos con menos pobreza. En niñas, en el 2005 y el 2013, la tasa en el tercil más pobre fue 1,5 y 2 veces mayor que la del primer tercil, respectivamente. Conclusión. Las desigualdades en la tasa de mortalidad por IRA de los municipios más pobres en comparación con la de los más ricos, continúan siendo un reto importante en salud pública

Inequalities on mortality due to acute respiratory infection in children: A Colombian analysis

Introduction: Acute respiratory infections (ARI) are a leading public health issue worldwide. Objective: To explore the inequalities in ARI mortality rates in under-5, according to socioeconomic characteristics. Materials and methods: We conducted an ecological analysis to study inequalities at municipal level due to ARI mortality in children under 5 years. The data were obtained from official death records of the Departamento Administrativo Nacional de Estadística. The analysis of inequalities in the under-5 mortality rate (U5MR) included: 1) Classification of the population in different socio-economic strata, and 2) measurement of the degree of inequality. We used the ARI-U5MR as an outcome measurement. The mortality rates were estimated at national and municipal levels for the years 2000, 2005, 2010, and 2013. Rate ratios, rates differences, and concentration curves were calculated to observe the inequalities. Results: A total of 18,012 children under 5 years died by ARI in Colombia from 2000 to 2013. ARIU5MR was greater in boys than in girls. During this period, an increase in the infant mortality relative gap in both boys and girls was observed. In 2013, the U5MR evidenced that for boys from municipalities with the highest poverty had a 1.6-fold risk to die than those in municipalities with the lowest poverty (low tercile). In girls, the ARI-U5MR for 2005 and 2013 in the poorest tercile was 1.5 and 2 times greater than in the first tercile, respectively. Conclusion: Colombian inequalities in the ARI mortality rate among the poorest municipalities compared to the richest ones continue to be a major challenge in public health

Erratum: Global, regional, and national comparative risk assessment of 84 behavioural, environmental and occupational, and metabolic risks or clusters of risks for 195 countries and territories, 1990–2017: a systematic analysis for the Global Burden of Disease Study 2017

Interpretation: By quantifying levels and trends in exposures to risk factors and the resulting disease burden, this assessment offers insight into where past policy and programme efforts might have been successful and highlights current priorities for public health action. Decreases in behavioural, environmental, and occupational risks have largely offset the effects of population growth and ageing, in relation to trends in absolute burden. Conversely, the combination of increasing metabolic risks and population ageing will probably continue to drive the increasing trends in non-communicable diseases at the global level, which presents both a public health challenge and opportunity. We see considerable spatiotemporal heterogeneity in levels of risk exposure and risk-attributable burden. Although levels of development underlie some of this heterogeneity, O/E ratios show risks for which countries are overperforming or underperforming relative to their level of development. As such, these ratios provide a benchmarking tool to help to focus local decision making. Our findings reinforce the importance of both risk exposure monitoring and epidemiological research to assess causal connections between risks and health outcomes, and they highlight the usefulness of the GBD study in synthesising data to draw comprehensive and robust conclusions that help to inform good policy and strategic health planning

Burden of disease due to microcephaly associated with the Zika virus in Colombia

En 2015, el virus del Zika fue introducido en Co¬lombia. La aparición de este arbovirus es un desa¬fío para el sistema de salud pública del país, debido a la asociación entre la infección y alteraciones congénitas como la microcefalia. Por estas razo¬nes, se estimó la carga de la enfermedad, debido a la microcefalia asociada al Zika en Colombia, así como en sus subdivisiones administrativas en el periodo 2015-2016. Se realizó un estudio ecológico de tipo exploratorio, usando como unidad de me¬dida los años de vida ajustados por discapacidad (DALYs, por sus siglas en inglés). Los casos de mi¬crocefalia debidos al Zika se obtuvieron de bases de datos nacionales y departamentales, construi¬das por el Sistema Nacional de Vigilancia en Sa¬lud Pública (SIVIGILA). Finalmente, se calcularon las tasas de mortalidad e incidencias, y posterior¬mente realizamos un análisis de sensibilidad bajo tres escenarios (conservador, medio y extremo), con el fin de estimar los DALYs. Durante el período de 2015-2016, se estimaron 10.609, 4 DALYs por microcefalia asociada con el Zika en Colombia. El 71% de los DALYs correspondieron a los años de vida perdidos y; el restante 29%, a los años vividos con discapacidad. Cinco de los 32 departamentos de Colombia (Meta, Córdoba, Tolima, Valle del Cauca y Norte de Santander) aportaron el 71% del total de DALYs. La carga de microcefalia aso¬ciada al Zika superó con creces la carga de otras alteraciones congénitas tales como defectos del tu¬bo neural y síndrome de Down en niños entre los 0-4 años en Colombia. Se deben realizar esfuerzos en salud pública para prevenir y monitorear estos casos.In 2015, the Zika virus was introduced in Colombia. The emergence of this arbovirus is a public health challenge for the country, considering the asso¬ciation between the infection and congenital disorders such as microcephaly. Thus, we estimated the burden of disease due to microcephaly associated with Zika in Colombia and its administrative subdivisions for the period 2015-2016. We conducted an exploratory ecological study, using as unit of mea¬surement disability-adjusted life years (DALYs). The cases of microcephaly were obtained from the Zika national and departmental databases built by the National Public Health Surveillance System (SIVIGILA). Deaths attributed to microcephaly were estimated from previous studies. Finally, we calculated mortality rates and incidences, then we performed a sensitivity analysis under three scenarios (conservative, medium, and extreme) to estimate the DALYs. In the 2015-2016 period, 10,609.4 DALYs were caused by microcephaly associ¬ated with Zika in Colombia. 71% of the total DALYs were years of life lost and 29% were years lived with disability. Five out of 32 departments (Meta, Cór¬doba, Tolima, Valle del Cauca, and Norte de Santander) contributed 71% of total DALYs. The burden of microcephaly associated with Zika outweighed the burden of other congenital anomalies such as neural tube defects and Down syndrome in children aged between 0 and 4 years in Colombia. Public health efforts must be made to prevent and monitor these cases

Laboratory-based surveillance of streptococcus pneumoniae invasive disease in children in 10 latin American countries: A SIREVA II project, 2000-2005

Durante los últimos 14 años la Organización Panamericana de la Salud ha estado promoviendo la vigilancia de la enfermedad neumocócica invasiva en niños latinoamericanos para comprender mejor las tendencias de la enfermedad en cuanto a la circulación de tipos capsulares en cada país y la susceptibilidad a los antimicrobianos. Métodos: Se analizaron los datos de vigilancia de laboratorio de 10 países latinoamericanos recopilados entre 2000 y 2005, incluida la distribución de serotipos y la susceptibilidad a los antibióticos betalactámicos. Resultados: Aunque se identificaron 61 tipos capsulares diferentes durante la vigilancia de 6 años, 13 serotipos representaron el 86% de todos los aislamientos. Estos fueron consistentemente los más prevalentes durante todo el período de estudio con predominio del serotipo 14. Se detectó una disminución de la susceptibilidad a la penicilina en el 38% de todos los aislados de Streptococcus pneumoniae, con mayor prevalencia en República Dominicana y México. La menor susceptibilidad a la penicilina aumentó en Brasil y Colombia, mientras que en Chile se registró una disminución de las tasas de alta resistencia. Conclusiones: Estos datos indican que 10 países de la Región continúan teniendo vigilancia de laboratorio de alta calidad para la enfermedad neumocócica generando información valiosa para que los tomadores de decisiones en salud puedan priorizar las intervenciones. La vacuna heptavalente cubrirá potencialmente del 52,4% al 76,5% de las cepas que causan la enfermedad neumocócica invasiva y la 13 valente del 76,7% al 88,3%. Copyright © 2009 de Lippincott Williams y Wilkins. Estos datos indican que 10 países de la Región continúan teniendo vigilancia de laboratorio de alta calidad para la enfermedad neumocócica generando así información valiosa para que los tomadores de decisiones en salud puedan priorizar las intervenciones. La vacuna heptavalente cubrirá potencialmente del 52,4% al 76,5% de las cepas que causan la enfermedad neumocócica invasiva y la 13 valente del 76,7% al 88,3%. Copyright © 2009 de Lippincott Williams y Wilkins. Estos datos indican que 10 países de la Región continúan teniendo vigilancia de laboratorio de alta calidad para la enfermedad neumocócica generando así información valiosa para que los tomadores de decisiones en salud puedan priorizar las intervenciones. La vacuna heptavalente cubrirá potencialmente del 52,4% al 76,5% de las cepas que causan la enfermedad neumocócica invasiva y la 13 valente del 76,7% al 88,3%.For the last 14 years the Pan American Health Organization has been promoting surveillance of invasive pneumococcal disease in Latin American children for better understanding of the disease tendencies regarding capsular types circulation in each country and susceptibility to antimicrobials. Methods: Laboratory-based surveillance data from 10 Latin American countries collected from 2000 to 2005 were analyzed, including serotype distribution and susceptibility to beta-lactam antibiotics. Results: Although 61 different capsular types were identified during the 6-year surveillance, 13 serotypes accounted for 86% of all isolates. These were consistently the most prevalent throughout the study period with serotype 14 predominating. Diminished susceptibility to penicillin was detected in 38% of all Streptococcus pneumoniae isolates, with the highest prevalence in Dominican Republic and Mexico. Decreased susceptibility to penicillin increased in Brazil and Colombia whereas decreased high resistance rates was recorded in Chile. Conclusions: These data indicate that 10 countries of the Region continue to have high quality laboratory-based surveillance for pneumococcal disease thus generating valuable information so that healthcare decision makers may prioritize interventions. The heptavalent vaccine will potentially cover from 52.4% to 76.5% of strains causing invasive pneumococcal disease and the 13 valent from 76.7% to 88.3%