Costos de hospitalización por agudos severos. infección respiratoria en tres centrales países americanos

Objective: To estimate the direct medical costs of severe acute respiratory infection (SARI) in children and adults from three Central American countries with a bottom-up costing approach. Methods: The costs of inpatients treatment were estimated through the retrospective bottom-up costing in a randomized sample of clinical records from SARI patients treated in teaching tertiary hospitals during 2009 - 2011 period. Activities incurred per patient were registered and a setting-specific cost per activity was acquired. Average cost per patient in the group of children and elderly adults was estimated for each country. In Nicaragua, only the pediatric population was included. Costs were expressed in local currency (2011), American dollars, and international dollars (2005) for country comparison. Results: The care cost per case in children in Guatemala was the cheaper (I$971.95) compared to Nicaragua (I$1,431.96) and Honduras (I$1,761.29). In adults, the treatment cost for Guatemala was the more expensive: I$4,065.00 vs. I$2,707.91 in Honduras. Conclusion: Bottom-up costing of SARI cases allowed the mean estimates per treated case that could have external validity for the target population diagnosed in hospitals with similar epidemiological profiles and level of complexity for the study countries. This information is very relevant for the decision-making.Objetivo: Estimar los costos médicos directos de la infección respiratoria aguda grave (IRAG) en niños y adultos de tres países de América Central con un enfoque de costos de abajo hacia arriba. Métodos: los costos del tratamiento de pacientes hospitalizados se calcularon mediante el cálculo retrospectivo de los costos ascendentes en una muestra aleatoria de registros clínicos de SARI. Pacientes tratados en hospitales terciarios docentes durante el periodo 2009 - 2011. Se registraron las actividades incurridas por paciente y se determinó un costo por actividad específico del entorno. adquirido. El costo promedio por paciente en el grupo de niños y adultos mayores se estimó para cada país. En Nicaragua, solo la población pediátrica era incluido. Los costos se expresaron en moneda local (2011), dólares estadounidenses y dólares internacionales (2005) para la comparación de países. Resultados: El costo de atención por caso en niños en Guatemala fue el más barato (I$ 971.95) en comparación con Nicaragua (I $1,431.96) y Honduras (I$ 1,761.29). En los adultos, el El costo del tratamiento para Guatemala fue el más caro: I $4,065.00 vs. I$ 2,707.91 en Honduras. Conclusión: el cálculo de costos ascendente de los casos de IRAG permitió las estimaciones medias por caso tratado que podrían tener validez externa para la población objetivo diagnosticada en Hospitales con perfiles epidemiológicos y nivel de complejidad similares para los países estudiados. Esta información es muy relevante para la toma de decisiones

Knowledge, attitudes, and practices of seasonal influenza vaccination in postpartum women, Honduras.

BackgroundInfluenza during pregnancy may cause serious neonatal outcomes including stillbirth, fetal distress, preterm birth, congenital abnormalities, and stunted growth. Pregnant women are the highest priority group for seasonal influenza vaccination, but low coverage has been repeatedly reported in this population. Understanding reasons for and for not receiving the seasonal influenza vaccine is needed to design communication strategies to increase vaccination coverage. This study aimed to describe knowledge, attitudes, and practices (KAP) of seasonal influenza vaccination among women giving birth in public maternity hospitals in Honduras.MethodsFrom August 20-October 8, 2018, we conducted a cross-sectional KAP survey regarding seasonal influenza vaccinations to a sample of postpartum women who gave birth in maternity hospitals and clinics from the Ministry of Health of Honduras and Honduran Social Security Institute. We reported frequency distributions for demographics, KAP of influenza vaccine, and vaccination coverage. We used logistic regression to analyze unadjusted and adjusted associations between sociodemographic characteristics and influenza vaccination.ResultsWe surveyed 842 postpartum women in 17 healthcare facilities. Of 534 postpartum women with term pregnancy and verified vaccinations, 417 (78.1%; 95% CI: 74.6-81.6%) were vaccinated for influenza. Factors associated with verified influenza vaccination included receipt of vaccination recommendations by a healthcare worker during prenatal check-ups (aOR: 16.46; 95% CI: 9.73-27.85), concurrent chronic disease (aOR: 5.00; 95% CI: 1.25-20.07), and influenza vaccination of other children in the household (aOR: 2.28; 95% CI: 1.19-4.39). The most cited reasons for vaccination were perceived benefits for both mother and infant and easy access. Reasons for non-vaccination were: vaccine was not offered and fear of side effects, harm to the infant, and needles or pain caused by injection.ConclusionInfluenza vaccination was well received among postpartum women in Honduras. Increasing clinician recommendations for vaccination and assuring the vaccine is readily available to women during prenatal visits may increase vaccination rates

Knowledge, attitudes, and practices of seasonal influenza vaccination in healthcare workers, Honduras.

BackgroundSeasonal influenza is a highly contagious vaccine-preventable disease that may cause high morbidity and mortality in susceptible populations. Healthcare workers are a priority group for seasonal influenza vaccination to protect them from contracting influenza and prevent nosocomial transmission to patients. This study aimed to evaluate knowledge, attitudes, and practices (KAP) of seasonal influenza vaccination among healthcare workers in Honduras.MethodFrom August 24 to October 21, 2018, we conducted a cross-sectional KAP survey regarding seasonal influenza vaccination to a random sample of healthcare workers who attended patients in hospitals of the Ministry of Health of Honduras (SESAL) and Honduran Social Security Institute (IHSS). We reported frequency distributions of demographics, vaccination KAP, sources of information, and reasons for non-vaccination. We used principal components factor analysis to create knowledge and attitude scores. We used linear regression to analyze associations between demographics and sources of information about the influenza vaccine, and knowledge and attitude scores. We used logistic regression to analyze associations between demographics, sources of information, knowledge scores, and attitude scores, and influenza vaccination.ResultWe surveyed 947 healthcare workers who attended patients in 13 SESAL hospitals and two IHSS hospitals. Only 4.6% of participants knew the seasonal influenza vaccine was composed of inactivated viruses, 94.7% believed vaccination causes flu-like symptoms, and 52.0% were vaccinated for influenza in 2018. Knowledge scores were lower for nursing assistants and other healthcare professionals compared to doctors, and higher for healthcare workers who attended a healthcare facility training (P-values≤0.030). Attitude scores were higher for healthcare workers who attended ≥11 patients per day having ≤10 patients per day as reference, self-reported influenza vaccination in previous year, and cited trainings and informal information at the healthcare facility as sources of information for influenza vaccination (P-values≤0.030). Factors associated with self-reported vaccination were self-reported influenza vaccination in previous year (aOR: 7.61; 95% CI: 5.24-11.04), attitude score (aOR: 1.14; 95% CI: 1.07-1.21), and worked in a SESAL hospital (aOR: 1.73; 95% CI: 1.12-2.68) having IHSS as reference.ConclusionAlthough influenza vaccination is required by law in Honduras and available for free in public health centers, coverage of healthcare workers in 2018 was half that reported in 2017. Lower coverage may be attributed to misconceptions of vaccination side effects

Burden of influenza-associated respiratory hospitalizations in the Americas, 2010-2015.

BACKGROUND:Despite having influenza vaccination policies and programs, countries in the Americas underutilize seasonal influenza vaccine, in part because of insufficient evidence about severe influenza burden. We aimed to estimate the annual burden of influenza-associated respiratory hospitalizations in the Americas. METHODS:Thirty-five countries in the Americas with national influenza surveillance were invited to provide monthly laboratory data and hospital discharges for respiratory illness (International Classification of Diseases 10th edition J codes 0-99) during 2010-2015. In three age-strata (<5, 5-64, and ≥65 years), we estimated the influenza-associated hospitalizations rate by multiplying the monthly number of respiratory hospitalizations by the monthly proportion of influenza-positive samples and dividing by the census population. We used random effects meta-analyses to pool age-group specific rates and extrapolated to countries that did not contribute data, using pooled rates stratified by age group and country characteristics found to be associated with rates. RESULTS:Sixteen of 35 countries (46%) contributed primary data to the analyses, representing 79% of the America's population. The average pooled rate of influenza-associated respiratory hospitalization was 90/100,000 population (95% confidence interval 61-132) among children aged <5 years, 21/100,000 population (13-32) among persons aged 5-64 years, and 141/100,000 population (95-211) among persons aged ≥65 years. We estimated the average annual number of influenza-associated respiratory hospitalizations in the Americas to be 772,000 (95% credible interval 716,000-829,000). CONCLUSIONS:Influenza-associated respiratory hospitalizations impose a heavy burden on health systems in the Americas. Countries in the Americas should use this information to justify investments in seasonal influenza vaccination-especially among young children and the elderly