How protective is cervical cancer screening against cervical cancer mortality in developing countries? The Colombian case

<p>Abstract</p> <p>Background</p> <p>Cervical cancer is one of the top causes of cancer morbidity and mortality in Colombia despite the existence of a national preventive program. Screening coverage with cervical cytology does not explain the lack of success of the program in reducing incidence and mortality rates by cervical cancer. To address this problem an ecological analysis, at department level, was carried out in Colombia to assess the relationship between cervical screening characteristics and cervical cancer mortality rates.</p> <p>Methods</p> <p>Mortality rates by cervical cancer were estimated at the department level for the period 2000-2005. Levels of mortality rates were compared to cervical screening coverage and other characteristics of the program. A Poisson regression was used to estimate the effect of different dimensions of program performance on mortality by cervical cancer.</p> <p>Results</p> <p>Screening coverage ranged from 28.7% to 65.6% by department but increases on this variable were not related to decreases in mortality rates. A significant reduction in mortality was found in departments where a higher proportion of women looked for medical advice when abnormal findings were reported in Pap smears. Geographic areas where a higher proportion of women lack health insurance had higher rates of mortality by cervical cancer.</p> <p>Conclusions</p> <p>These results suggest that coverage is not adequate to prevent mortality due to cervical cancer if women with abnormal results are not provided with adequate follow up and treatment. The role of different dimensions of health care such as insurance coverage, quality of care, and barriers for accessing health care needs to be evaluated and addressed in future studies.</p

Efectividad de la vacuna contra rotavirus en la hospitalización por diarrea en niños menores de dos años en cinco ciudades de Colombia

Introducción: La enfermedad diarreica aguda (EDA) es la segunda causa de muerte a nivel mundial en menores de cinco años. El rotavirus es el principal entero-patógeno asociado a EDA severa por lo cual se ha iniciado la vacunación contra este virus en Colombia. Este trabajo evaluó la efectividad de la vacunación contra la hospitalización por diarrea en niños menores de dos años en cinco ciudades de Colombia.\ud Metodología: Análisis de sobrevida para estimar la efectividad de la vacuna contra el rotavirus en la prevención de hospitalización por EDA, basado en los datos de una encuesta poblacional realizada en niños menores de dos años de Bogotá, Barranquilla, Cali, Cartagena y Riohacha, en la que se recolectó información socio-demográfica, de vacunación, factores de riesgo para EDA y antecedentes de EDA. \ud Resultados: Incidencia acumulada de hospitalización por diarrea de 5,3%. Cobertura de vacunación fue de 88,5% y 78% para primera y segunda dosis respectivamente. La vacunación con dos dosis presentó una efectividad de 52,4% IC 95% (13,2% a 73,9%) en la prevención de hospitalizaciones por EDA y la vacunación adecuada una efectividad de 59,5% IC 95% (23,9% a78,4%). El sexo masculino y la ciudad de residencia (Riohacha) se asociaron al riesgo de hospitalización.\ud \ud \ud Conclusiones: La vacunación contra rotavirus mostro ser efectiva en la prevención de la hospitalización por EDA. Las coberturas de vacunación y la adherencia al esquema presentan deficiencias que requieren medidas para asegurar la vacunación de todos los niños antes de los seis meses..Organización Panamericana de la SaludIntroduction: Acute diarrhea is the second global cause of child mortality. Rotavirus is the leading pathogen associated to severe diarrhea therefore vaccination against this virus has been initiated in Colombia. This study evaluated vaccine effectiveness against diarrhea hospitalization in children under two years old in Colombia.\ud Methods: Vaccine effectiveness was estimated though survival analysis based on a population survey on children under two years old living in Bogotá, Barranquilla, Cali, Cartagena and Riohacha. Information was collected on socio-demographic characteristics, vaccination status, risk factors for severe diarrhea and past diarrhea episodes. \ud Results: Cumulated incidence of diarrhea hospitalization was 5,3%. Vaccine coverage was 88,5% and 78% for the first and second dose respectively. Vaccine effectiveness for prevention of diarrhea hospitalization was 52,4% CI95% (13,2% a 73,9%) the two doses scheme. Adequate vaccination effectiveness was 59,5% CI95% (23,9% a78,4%). Male sex and living in Riohacha were also identified as risk factors for diarrhea hospitalization. \ud Conclusions: Vaccination against rotavirus was shown to be effective in the prevention of diarrhea hospitalizations. Deficiencies exist in vaccination coverage and compliance with vaccination schedules and actions need to be taken in order to guarantee vaccination before six months of age