Changes in the endemic-epidemic pattern of malaria in Colombia, 1978-2021.

BACKGROUND: Malaria is a major global public health issue with varying epidemiologies across countries. In Colombia, it is a priority endemic-epidemic event included in the national public health policy. However, evidence demonstrating nationwide variations in the disease behavior is limited. This study aimed to analyze changes in the levels and distribution of endemic-epidemic malaria transmission in the eco-epidemiological regions of Colombia from 1978 to 1999 and 2000 to 2021. METHODS: We conducted a comprehensive time-series study using official secondary data on malaria-associated morbidity and mortality in Colombia from 1978 to 2021. Temporal-spatial and population variables were analyzed, and the absolute and relative frequency measures of general and regional morbidity and mortality were estimated. RESULTS: We observed an 18% reduction in malaria endemic cases between the two study periods. The frequency and severity of the epidemic transmission of malaria varied less and were comparable across both periods. A shift was observed in the frequency of parasitic infections, with a tendency to match and increase infections by Plasmodium falciparum. The risk of malaria transmission varied significantly among the eco-epidemiological regions during both study periods. This study demonstrated a sustained decrease of 78% in malarial mortality. CONCLUSIONS: Although the endemic components of malaria decreased slightly between the two study periods, the epidemic pattern persisted. There were significant variations in the risk of transmission across the different eco-epidemiological regions. These findings underscore the importance of targeted public health interventions in reducing malarial morbidity and mortality rates in Colombia.

Analysis of Inequalities and Inequities in Maternal Mortality in Chocó, Colombia.

We used a mixed design study to analyze the inequalities and inequities in Maternal Mortality (MM) for Chocó (Colombia) between 2010-2018. The quantitative component consisted of an analytical ecological design, where proportions, ratios, measures of central tendency and rates ratios, rate difference, Gini and concentration indices were calculated to measure inequalities. The qualitative component had a phenomenological and interpretive approach. One hundred thirty-one women died in Choco between 2010-2018. The Maternal Mortality Ratio was 224/100.000 live births. The Gini coefficient was 0.35, indicating inequality in the distribution of the number of MM with respect to live births. The health service offers have been concentrated in the private sector in urban areas (77%). The exercise of midwifery has played an important role in maternal and perinatal care processes, especially in territories where the State has been absent. Nevertheless, it occurs in complex circumstances such as the armed conflict, lack of transportation routes, and income deficits, affecting the timelines and care quality for these vulnerable groups. MM in Chocó has been a consequence of deficiencies in the health system and weaknesses in its infrastructure (absence of a high level of maternal-perinatal care). This is in addition to the territory's geographical characteristics, which increase vulnerability and health risks for women and their newborns. In Colombia, as well as in other countries, many maternal and newborn deaths are preventable because their causes are due to social injustices.

Educational inequalities in heart failure mortality and the cycles of the internal armed conflict in Colombia: An observational panel study of ecological data, 1999-2017.

Heart failure (HF) is a significant clinical problem and an important public health issue due to the morbidity and mortality that it causes, especially in a population that is aging and affected by social stressors such as armed conflict. We aim to describe the inequalities and trends of HF mortality by educational level in Colombia between 1999 and 2017 compared with the cycles of the internal armed conflict during the same period. An observational study of ecological data panels, with aggregates at the national level, was conducted. Information from death certificates with HF as the basic cause of death (COD) was used. Variables of the year of death, sex, age, department of residence, and educational level were considered. Mortality rates adjusted for age were calculated. A joinpoint regression was used to model the trend of rates by educational level. We found that both men and women with primary education had the highest adjusted mortality rates: among men, RR_primary = 19.06 deaths/100,000 inhabitants, SE = 0.13 vs. RR_tertiary = 4.85, SE = 0.17, and similar differences among women. Mortality rates tended to decrease at all educational levels, with a greater reduction in people with higher educational levels. In both sexes, the behavior of the relative index of inequality showed significant inequality, albeit with a strong reduction during the last decade. Mortality due to HF in Colombia shows inequalities by educational level. In the prevention of HF, education should be considered a structural social determinant. In addition, we analyzed the potential role of the Colombian long-term armed conflict in the observed trends. We highlighted the role of the health sector, together with other sectors (education, work, and housing), in developing intersectoral public policies that contribute to the reduction of cardiovascular mortality disparities.

How Expensive Are Hospitalizations by COVID-19? Evidence From Colombia.

OBJECTIVES: This study aimed to estimate the direct medical costs due to hospitalizations by COVID-19 in Colombia and to identify their cost drivers in Colombia. METHODS: This is a retrospective cost-of-illness study of COVID-19 in Colombia. We estimated direct medical costs using data from patients insured to a Benefit Plan Administrator Company, between March 15, 2020 and May 29, 2020. Absolute and relative frequencies, averages, medians, and interquartile ranges (IQRs) were used to characterize the population and estimate the costs of hospitalized patients with COVID-19. We stratified the cost analysis by sex, age groups, comorbidities, and type of hospitalization (general ward and intensive care unit [ICU]). Cost drivers were calculated from a generalized linear model. RESULTS: We studied 113 confirmed patients, 51.3% men. On average, the hospital length of stay was 7.3 (± 6.2) days. A person hospitalized with COVID-19 reported median costs of $1688 (IQR 788-2523). In women, this cost was $1328 (IQR 463-2098); in men, this was 1.4 times greater. The median cost for ICU was $4118 (IQR 2069-5455), 3 times higher than those hospitalized only in the general ward. Admission to the ICU, having 1 comorbidity, length of stay, high blood pressure, having 5 comorbidities, and being treated in the city of Cartagena were statistically significant with direct medical costs. CONCLUSIONS: Our study provides an idea of the magnitude of costs needed to hospitalize a COVID-19 case in Colombia. Other studies in Colombia have assessed the costs of hospitalization for infectious diseases such as influenza, costs significantly lower than those described here.

Substantial Out-of-Pocket Health Expenditure on Prenatal Check-Ups: Estimates from a Sample of Pregnant Women in Cartagena, Colombia.

OBJECTIVE: We aimed to estimate out-of-pocket (OOP) health expenditures and the indirect costs related to prenatal check-ups in pregnant women seen in a maternity hospital in the Colombian Caribbean region. METHODS: We described the economic costs of pregnant women, with no age limits, who attended prenatal check-ups in a maternity hospital. To estimate OOP and indirect costs owing to prenatal check-ups in pregnant women, a survey was constructed, where the woman was asked about some sociodemographic variables, to characterize those attending the prenatal check-ups. Absolute and relative frequencies, averages and confidence intervals were used to characterize the population and estimate OOP and indirect costs in pregnant women. The latter were estimated from the percentile method. A bootstrapping was performed to reduce the bias within the analysis. RESULTS: In total, 56 pregnant women were surveyed, with an average age of 25.9 years (±6.2). All women surveyed had OOP associated to the prenatal check-up in at least one cost-item, and the OOP ranged between $0.3 and $108.7. Transportation was the item with the highest frequency of expenses, followed by food, other expenses, and drugs. The mean of OOP expenditures was $24.3 (CI 95% $18.1-31.4) for women who attended their prenatal check-up. DISCUSSION: Considering the estimated OOP health expenditures caused by prenatal check-ups by household income, women living with <1 minimum wage spend 7% of their income in a prenatal check-up. In women with 1-2 and >2-3 minimum wages, these proportions were 5%, 3%, respectively. Unfortunately, this makes prenatal care a significant source of economic burden, impacting poor households in Cartagena.

Malaria prevalence in Commune 5 in Tumaco (Nariño, Colombia).

Background Urban malaria is a public health problem in Colombia and there is still lack of knowledge about its epidemiological characteristics, which are key to the implementation of control measures. The presence of urban malaria cases and disease diagnosis are some of the challenges faced by malaria elimination programs. The objective of this research was to estimate malaria prevalence, explore associated factors and detect pfhrp 2/3 genes, in the urban area of Tumaco between July and December 2019. Methods A prevalence study was conducted by using a stratified random probability sample. Structured surveys were administered and blood samples were taken and examined through optical microscopy, rapid diagnostic tests (RDT) and polymerase chain reaction (PCR). A logistic regression model was used to explore associated factors. Results 1,504 people living in 526 households were surveyed. The overall prevalence was 2.97% (95% CI: 2.1 - 4.3%). It was higher in males, in the 10-19 age group and in asymptomatic cases. The prevalence of pfhrp2 amplification was 2.16% (95% CI: 1.6 - 2.9%). Households with three or more people had a higher risk of malaria infection (adjusted odds ratio (ORa) 4.05; 95% confidence interval (CI) 1.57-10.43). All cases were due to P. falciparum. Conclusions The prevalence of urban malaria was low. Strategies to eliminate malaria in urban areas should be adjusted considering access to early diagnosis, asymptomatic infection, and the RDTs used to detect the presence of the pfhrp2 gene.

Variantes Alpha y Gamma del SARS-CoV-2: revisión rápida para contribuir en la toma de decisiones / Alpha and Gamma variants of SARS-CoV-2: rapid review to aid decision-making

Resumen Objetivo: Describir el riesgo de transmisión y severidad de las variantes de preocupación Alpha y Gamma del SARS-CoV-2 en comparación con otras variantes. Materiales y métodos: Revisión rápida y narrativa de literatura realizada en PubMed hasta mayo 10 de 2021. Resultados: La búsqueda capturó 262 artículos, de los cuales se incluyeron 15 estudios. Cuatro fueron incluidos en el control de referencias. De los 19 estudios, 6 corresponden con literatura gris. La mayoría de los estudios analizaron la variante de preocupación Alpha, solo uno para Gamma. La variante de preocupación Alpha es consistente con mayor riesgo de transmisión (entre el 35 y 89 % mayor riesgo), de hospitalización (entre 64 y 234 % mayor riesgo) y de muerte (entre 36 y 140 % mayor riesgo) en comparación con otras variantes. La variante de preocupación Gamma reporta una posible correlación fuerte y positiva entre proporción positivos y las muertes (Rho 0,71; p <0,01). Conclusiones: Se encuentra más información de la variante de preocupación Alpha que de Gamma. La variante de preocupación Alpha reporta mayor riesgo de transmisión, hospitalización y muerte en comparación con otras variantes; pero estos resultados deben tomarse con precaución.

Abstract Objective: To describe the transmission and severity risk of the Alpha and Gamma variants concerning SARS-CoV-2 compared with other variants. Materials and methods: Narrative and rapid review conducted in PubMed up to May 10, 2021. Results: The search captured 262 articles, of which 15 studies were included. Four studies were included from the reference control. Six out of the 19 studies were gray literature. Most of the studies analyzed the variant of concern, Alpha, and only one for the Gamma variant. The variant of concern, Alpha, is consistent with a higher risk of transmission (between 35 and 89% higher risk), hospitalization (between 64 and 234% higher risk) and death (between 36 and 140% higher risk) compared to other variants. The Gamma variant reports a possible strong and positive correlation between positive proportions and deaths (Rho 0.71; p <0.01). Conclusions: There is more information regarding the variant of concern Alpha than Gamma. The variant of concern Alpha reports a higher risk of transmission, hospitalization, and death; but these results should be viewed with caution.

Trends in diabetes mortality identified from death certificates in Colombia, 1979-2017.

OBJECTIVE: To describe the mortality trends of diabetes mellitus (DM) in Colombia, by sex and age group, from 1979 to 2017. METHODS: We carried out an ecological study using mortality data from the Colombian National Administrative Department of Statistics. Crude and age-standardized annual mortality rates per 100 000 people were estimated. Trends of standardized rates were described by sex and age groups. Joinpoint regression models were performed to study mortality trends. RESULTS: Throughout the whole period, the total number of DM recorded deaths in Colombia was 200 650, 58% (116 316) in women (p<0.05). The age-standardized mortality rates (ASMR) by sex increased from 13.2 to 26.6 deaths per 100 000 in women and from 10.1 to 22.7 in men from 1979 to 1999. We observed a decrease from 26.6 to 15.4 per 100 000 in women, and from 22.7 to 15.9 in men for the period 1999-2017. The joinpoint regression analysis showed that the average annual percentage change of the period did not vary in both sexes (men: -0.2%, 95% CI -1.0 to 1.4%; women: 0.7%, 95% CI -0.1 to 1.6%). CONCLUSIONS: The DM mortality showed a decreasing trend after 2000 in women and 2004 in men. Primary and secondary prevention programs must continue to be strengthened for an earlier diagnosis of diabetes.

OBJETIVO: Describir las tendencias de la mortalidad por diabetes mellitus (DM) en Colombia, por sexo y grupo de edad, entre 1979 y 2017. MÉTODOS: Estudio ecológico con datos de mortalidad del Departamento Administrativo Nacional de Estadística de Colombia. Se estimaron las tasas de mortalidad anuales brutas y ajustadas por edad por cada 100 000 personas. Se describieron las tendencias de las tasas ajustadas por sexo y grupos de edad. Se realizaron modelos de regresión joinpoint para estudiar las tendencias de la mortalidad. RESULTADOS: En el período del estudio, el número total de muertes por DM registradas en Colombia fue de 200 650, el 58% (116 316) en mujeres (p<0,05). Las tasas de mortalidad ajustadas por edad, en cada sexo, aumentaron de 13,2 a 26,6 muertes por 100 000 en las mujeres y de 10,1 a 22,7 en los hombres entre 1979 y 1999. En el período 1999-2017 se observó una disminución de 26,6 a 15,4 por 100 000 en las mujeres y de 22,7 a 15,9 en los hombres. El análisis de regresión joinpoint demostró que el cambio porcentual anual medio del período no varió en ambos sexos (hombres: ­0,2%, IC 95% ­1,0 a 1,4%; mujeres: 0,7%, IC 95% ­0,1 a 1,6%). CONCLUSIONES: La mortalidad por DM mostró una tendencia decreciente después del año 2000 en las mujeres y del 2004 en los hombres. Es necesario seguir fortaleciendo los programas de prevención primaria y secundaria a fin de alcanzar un diagnóstico más temprano de la diabetes.

Trends in diabetes mortality identified from death certificates in Colombia, 1979-2017 / Tendencias de la mortalidad por diabetes identificadas a partir de los certificados de defunción en Colombia, 1979-2017

ABSTRACT Objective. To describe the mortality trends of diabetes mellitus (DM) in Colombia, by sex and age group, from 1979 to 2017. Methods. We carried out an ecological study using mortality data from the Colombian National Administrative Department of Statistics. Crude and age-standardized annual mortality rates per 100 000 people were estimated. Trends of standardized rates were described by sex and age groups. Joinpoint regression models were performed to study mortality trends. Results. Throughout the whole period, the total number of DM recorded deaths in Colombia was 200 650, 58% (116 316) in women (p<0.05). The age-standardized mortality rates (ASMR) by sex increased from 13.2 to 26.6 deaths per 100 000 in women and from 10.1 to 22.7 in men from 1979 to 1999. We observed a decrease from 26.6 to 15.4 per 100 000 in women, and from 22.7 to 15.9 in men for the period 1999-2017. The joinpoint regression analysis showed that the average annual percentage change of the period did not vary in both sexes (men: -0.2%, 95% CI -1.0 to 1.4%; women: 0.7%, 95% CI -0.1 to 1.6%). Conclusions. The DM mortality showed a decreasing trend after 2000 in women and 2004 in men. Primary and secondary prevention programs must continue to be strengthened for an earlier diagnosis of diabetes.

RESUMEN Objetivo. Describir las tendencias de la mortalidad por diabetes mellitus (DM) en Colombia, por sexo y grupo de edad, entre 1979 y 2017. Métodos. Estudio ecológico con datos de mortalidad del Departamento Administrativo Nacional de Estadística de Colombia. Se estimaron las tasas de mortalidad anuales brutas y ajustadas por edad por cada 100 000 personas. Se describieron las tendencias de las tasas ajustadas por sexo y grupos de edad. Se realizaron modelos de regresión joinpoint para estudiar las tendencias de la mortalidad. Resultados. En el período del estudio, el número total de muertes por DM registradas en Colombia fue de 200 650, el 58% (116 316) en mujeres (p<0,05). Las tasas de mortalidad ajustadas por edad, en cada sexo, aumentaron de 13,2 a 26,6 muertes por 100 000 en las mujeres y de 10,1 a 22,7 en los hombres entre 1979 y 1999. En el período 1999-2017 se observó una disminución de 26,6 a 15,4 por 100 000 en las mujeres y de 22,7 a 15,9 en los hombres. El análisis de regresión joinpoint demostró que el cambio porcentual anual medio del período no varió en ambos sexos (hombres: -0,2%, IC 95% -1,0 a 1,4%; mujeres: 0,7%, IC 95% -0,1 a 1,6%). Conclusiones. La mortalidad por DM mostró una tendencia decreciente después del año 2000 en las mujeres y del 2004 en los hombres. Es necesario seguir fortaleciendo los programas de prevención primaria y secundaria a fin de alcanzar un diagnóstico más temprano de la diabetes.

The trend in mortality due to suicide in urban and rural areas of Colombia, 1979-2014 / Tendencia de la mortalidad por suicidio en las áreas urbanas y rurales de Colombia, 1979-2014

Introduction: Suicide is a serious social and public health problem that affects the population in most countries in the world. Differences in suicide rates in rural and urban areas have been previously described. Objective: To study the trend of mortality rates by suicide in Colombia, in rural and urban areas by gender, age group, and suicide method during the years 1979-2014. Materials and methods: We conducted a temporal trend ecologic study using death certificates from the Departamento Administrativo Nacional de Estadística, DANE. Specific and adjusted by age and gender mortality rates were calculated. We estimated negative binomial and inflection point regression models to study the trends in mortality rates stratified by gender, age group, and suicide method. Results: A total of 56,448 suicides was reported in Colombia between 1979 and 2014. The risk of suicide was higher in urban areas for men, individuals between 25 and 44 years, and 65 and over; and for those who used hanging as the suicide method. Also, the risk of suicide was higher in the rural area for men between 45 and 64 years old, and those who used firearms, sharp weapons, hanging, and others as suicide methods. The trend of suicide rates in urban areas showed its maximum peak in 1999 and in the rural ones in 2000. Then, in the two areas, there was a gradual decrease. Hanging in both areas presented a tendency to rise in men. Conclusions: Suicide has shown a tendency toward reduction after the year 2000, with differences between urban and rural areas.

Introducción. El suicidio es un grave problema social y de salud pública que afecta a la población de la mayoría de los países del mundo. Se han descrito diferencias en las tasas de suicidio entre las áreas rurales y las urbanas. Objetivo. Estudiar la tendencia de las tasas de mortalidad por suicidio en Colombia en las áreas de defunción rural y urbana y según sexo, grupo de edad y método de suicidio para el periodo 1979-2014. Materiales y métodos. Se realizó un estudio ecológico de tendencia temporal a partir de la información de mortalidad del Departamento Administrativo Nacional de Estadística. Se calcularon las tasas de mortalidad específica y ajustada por edad y sexo. Las tendencias de las tasas por área para el periodo de estudio, y tanto por sexo y grupo de edad como por método de suicidio, se estudiaron mediante modelos negativos de regresión binomial y regresión de puntos de inflexión. Resultados. Un total de 56.448 suicidios se registró en Colombia entre 1979 y 2014. El riesgo de suicidio fue más alto en el área urbana en hombres, en los grupos etarios de 25 a 44 años y de 65 y más años, y en quienes emplearon el ahorcamiento. El riesgo de suicidio fue mayor en el área rural para los hombres entre los 45 y los 64 años, y para aquellos que recurrieron al disparo de armas de fuego, armas cortantes, ahorcamiento y otros. La tendencia de las tasas en el área urbana mostró su máximo pico en 1999 y, en la rural, en el 2000; posteriormente, en ambas áreas se produjo un descenso paulatino. El ahorcamiento presentó una tendencia al ascenso en hombres en las dos áreas. Conclusión. El suicidio ha mostrado una tendencia hacia la reducción después del año 2000, con diferencias entre las áreas urbanas y las rurales.

Tendencia de la mortalidad por suicidio en las áreas urbanas y rurales de Colombia, 1979-2014

Introducción. El suicidio es un grave problema social y de salud pública que afecta a la población de la mayoría de los países del mundo. Se han descrito diferencias en las tasas de suicidio entre las áreas rurales y las urbanas. Objetivo. Estudiar la tendencia de las tasas de mortalidad por suicidio en Colombia en las áreas de defunción rural y urbana y según sexo, grupo de edad y método de suicidio para el periodo 1979-2014. Materiales y métodos. Se realizó un estudio ecológico de tendencia temporal a partir de la información de mortalidad del Departamento Administrativo Nacional de Estadística. Se calcularon las tasas de mortalidad específica y ajustada por edad y sexo. Las tendencias de las tasas por área para el periodo de estudio, y tanto por sexo y grupo de edad como por método de suicidio, se estudiaron mediante modelos negativos de regresión binomial y regresión de puntos de inflexión. Resultados. Un total de 56.448 suicidios se registró en Colombia entre 1979 y 2014. El riesgo de suicidio fue más alto en el área urbana en hombres, en los grupos etarios de 25 a 44 años y de 65 y más años, y en quienes emplearon el ahorcamiento. El riesgo de suicidio fue mayor en el área rural para los hombres entre los 45 y los 64 años, y para aquellos que recurrieron al disparo de armas de fuego, armas cortantes, ahorcamiento y otros. La tendencia de las tasas en el área urbana mostró su máximo pico en 1999 y, en la rural, en el 2000; posteriormente, en ambas áreas se produjo un descenso paulatino. El ahorcamiento presentó una tendencia al ascenso en hombres en las dos áreas. Conclusión. El suicidio ha mostrado una tendencia hacia la reducción después del año 2000, con diferencias entre las áreas urbanas y las rurales.

Introduction: Suicide is a serious social and public health problem that affects the population in most countries in the world. Differences in suicide rates in rural and urban areas have been previously described. Objective: To study the trend of mortality rates by suicide in Colombia, in rural and urban areas by gender, age group, and suicide method during the years 1979-2014. Materials and methods: We conducted a temporal trend ecologic study using death certificates from the Departamento Administrativo Nacional de Estadística, DANE. Specific and adjusted by age and gender mortality rates were calculated. We estimated negative binomial and inflection point regression models to study the trends in mortality rates stratified by gender, age group, and suicide method. Results: A total of 56,448 suicides was reported in Colombia between 1979 and 2014. The risk of suicide was higher in urban areas for men, individuals between 25 and 44 years, and 65 and over; and for those who used hanging as the suicide method. Also, the risk of suicide was higher in the rural area for men between 45 and 64 years old, and those who used firearms, sharp weapons, hanging, and others as suicide methods. The trend of suicide rates in urban areas showed its maximum peak in 1999 and in the rural ones in 2000. Then, in the two areas, there was a gradual decrease. Hanging in both areas presented a tendency to rise in men. Conclusions: Suicide has shown a tendency toward reduction after the year 2000, with differences between urban and rural areas.

Identificación de los conocimientos de calidad de la información de mortalidad en Bogotá / Identification of knowledge about the quality of mortality information in Bogotá

RESUMEN Objetivo Identificar los conocimientos del personal que participaba en la producción y el uso de la información de mortalidad sobre la calidad de la misma, durante el año 2010. Métodos Estudio descriptivo que aplicó encuesta semi-estructurada, auto-administrada a 130 funcionarios que participaban en la producción y uso de estadísticas de mortalidad. Sobre los conocimientos de calidad de la información de mortalidad, se indagaron aspectos que daban cuenta de fiabilidad, características, calificación, explicación a la calificación dada y propuesta para mejorar. Se calcularon frecuencias y distribuciones porcentuales. Resultados El 76,2 % de los encuestados identificaron cobertura y contenido como aspectos que daban cuenta de la fiabilidad de la información de mortalidad. Las principales características de calidad de la información reconocidas fueron veracidad, 80,8 %; completitud, 76,2 %; precisión, 75,4 %; oportunidad, 74,6 %; y validez, 73,8 %. El 55,4 % de los participantes calificó la calidad como regular y el 6,2 % como mala. Sensibilización, procesos formativos y evaluativos fueron algunas de las propuestas mencionadas para el mejoramiento de la calidad. Conclusiones Los hallazgos sugieren que existe falta de conocimientos sobre la calidad de la información de mortalidad. Se hace necesario corregir esa falta de conocimientos poniendo en práctica las propuestas de mejoramiento realizada por los encuestados. Se recomendó que las distintas propuestas que se pongan en marcha, sean seguidas y evaluadas para conocer el impacto que ellas producen.(AU)

ABSTRACT Objective Identify the workers knowledge involved in the production and usage, about the quality of mortality information in Bogotá during 2006. Methods We conducted a descriptive study using a self-administered and semi-structured questionnaire in 130 functionaries who participated in the mortality data production and use. The instruments inquired into the reliability, characteristics, qualification, reasons for that qualification and improvement proposals. We calculated frequencies and percentage distributions. Results 76.2 % of respondents identified coverage and content as the aspects that best indicated reliability of mortality information. The main quality characteristics of the information recognized were veracity, 80.8 %; completeness, 76.2 %; accuracy, 75.4 %; opportunity, 74.6 %; and validity, 73.8 %. 55.4 % of participants rated the quality as fair and 6.2 % as poor. Some of the proposals for the quality improvement were awareness, training and evaluation processes. Conclusions The findings suggest that there is still a lack of knowledge about the quality of mortality information in people involved in its production and use. It is necessary to correct this lack of knowledge by implementing the proposals to improve the quality of mortality data made by respondents. It is recommended that the various proposals that were exposed are monitored and evaluated to determine the impact they produce.(AU)

Individual and climate factors associated with acute respiratory infection in Colombian children.

The objective of this study was to examine the association between acute respiratory infection recall (ARI-recall) and individual and environmental factors such as climate, precipitation, and altitude above sea level in Colombian children. A secondary analysis of 11,483 Colombian children, whose mothers were interviewed in the 2010 National Demographic and Health Survey, was carried out. The outcome variable was the mother's or caregiver's ARI-recall. The independent variables were expressed at individual, cluster, and municipal levels. At the individual level, we considered health and individual characteristics of the children; at cluster level, we incorporated the altitude above sea level; and at the municipal level, we included precipitation and annual average climate. The association between ARI-recall and independent variables was assessed using a multilevel logistic regression model. ARI-recall was significantly associated with age (OR = 0.61; 95%CI: 0.48-0.79), belonging to an indigenous group (OR = 1.51; 95%CI: 1.16-1.96), and a medium or very poor wealth index (OR = 2.03; 95%CI: 1.25-3.30 and OR = 1.75; 95%CI: 1.08-2.84, respectively). We found interaction between acute child malnutrition and average annual precipitation. Children with acute malnutrition and from municipalities with high annual precipitation had significantly 3.6-fold increased risk of ARI-recall (OR = 3.6; 95%CI: 1.3-10.1). Individual conditions and precipitation are risk factors for ARI-recall in Colombian children. These results could be useful to understand ARI occurrence in children living in tropical countries with similar characteristics.

Individual and climate factors associated with acute respiratory infection in Colombian children / Factores individuales y climáticos asociados a la infección respiratoria aguda en niños colombianos / Fatores individuais e climáticos associados à infecção respiratória aguda em crianças colombianas

The objective of this study was to examine the association between acute respiratory infection recall (ARI-recall) and individual and environmental factors such as climate, precipitation, and altitude above sea level in Colombian children. A secondary analysis of 11,483 Colombian children, whose mothers were interviewed in the 2010 National Demographic and Health Survey, was carried out. The outcome variable was the mother's or caregiver's ARI-recall. The independent variables were expressed at individual, cluster, and municipal levels. At the individual level, we considered health and individual characteristics of the children; at cluster level, we incorporated the altitude above sea level; and at the municipal level, we included precipitation and annual average climate. The association between ARI-recall and independent variables was assessed using a multilevel logistic regression model. ARI-recall was significantly associated with age (OR = 0.61; 95%CI: 0.48-0.79), belonging to an indigenous group (OR = 1.51; 95%CI: 1.16-1.96), and a medium or very poor wealth index (OR = 2.03; 95%CI: 1.25-3.30 and OR = 1.75; 95%CI: 1.08-2.84, respectively). We found interaction between acute child malnutrition and average annual precipitation. Children with acute malnutrition and from municipalities with high annual precipitation had significantly 3.6-fold increased risk of ARI-recall (OR = 3.6; 95%CI: 1.3-10.1). Individual conditions and precipitation are risk factors for ARI-recall in Colombian children. These results could be useful to understand ARI occurrence in children living in tropical countries with similar characteristics.

El objetivo del estudio fue examinar la asociación entre el historial de infección respiratoria aguda (IRA) y factores individuales y ambientales, tales como clima, precipitación y altitud por encima del nivel del mar en niños colombianos. Se realizó un análisis secundario de datos de 11.483 niños colombianos, cuyas madres fueron entrevistadas por la Encuesta Nacional de Demografía y Salud de 2010. La variable dependiente era el historial de IRA informado por la madre o cuidador(a). Las variables independientes se expresaron en el nivel individual, de clúster y municipal. En el nivel individual, consideramos las características individuales y de salud de los niños; en nivel de clúster, incorporamos la altitud sobre el nivel del mar y, en nivel municipal, incluimos la precipitación y el clima medio anual. La asociación entre el historial de IRA y las variables independientes se evaluaron con un modelo de regresión logística multinivel. El historial de IRA mostró una asociación significativa con la edad (OR = 0,61; IC95%: 0,48-0,79), pertenecer a un grupo indígena (OR = 1,51; IC95%: 1,16-1,96) y al estrato socioeconómico médio o muy bajo (OR = 2,03; IC95%: 1,25-3,30 y OR = 1,75; IC95%: 1,08-2,84, respectivamente). Identificamos una interacción entre la desnutrición infantil aguda y la precipitación anual promedio. Los niños con desnutrición aguda y aquellos de municipios con precipitaciones anuales altas mostraron un riesgo significativo 3,6 veces mayor de historial de IRA (OR = 3,6; IC95%: 1,3-10,1). Las condiciones individuales y la precipitación son factores de riesgo para el historial de IRA en niños colombianos. Los resultados pueden ser útiles para comprender la ocurrencia de IRA en niños que viven en países tropicales con características semejantes.

O estudo teve como objetivo examinar a associação entre história de infecção respiratória aguda (IRA) e fatores individuais e ambientais tais como clima, precipitação e altura acima do nível do mar em crianças colombianas. Foi realizada uma análise secundária dos dados de 11.483 crianças colombianas cujas mães foram entrevistadas pela Pesquisa Nacional de Demografia e Saúde de 2010. A variável dependente era história de IRA informada pela mãe ou cuidador(a). As variáveis independentes foram expressas em nível individual, de cluster e municipal. No nível individual, consideramos as características individuais e de saúde das crianças; em nível de cluster, incorporamos a altitude acima do nível do mar e em nível municipal, incluímos a precipitação e o clima médio anual. A associação entre história de IRA e variáveis independentes foi avaliada com um modelo de regressão logística multinível. A história de IRA mostrou associação significativa com idade (OR = 0,61; IC95%: 0,48-0,79), pertencer a grupo indígena (OR = 1,51; IC95%: 1,16-1,96) e estrato socioeconômico médio ou muito baixo (OR = 2,03; IC95%: 1,25-3,30 e OR = 1,75; IC95%: 1,08-2,84, respectivamente). Identificamos interação entre desnutrição infantil aguda e precipitação anual média. As crianças com desnutrição aguda e aquelas de municípios com precipitação anual alta mostraram um risco significativo 3,6 vezes maior de história de IRA (OR = 3,6; IC95%: 1,3-10,1). As condições individuais e a precipitação são fatores de risco para história de IRA em crianças colombianas. Os resultados podem ser úteis para compreender a ocorrência de IRA em crianças vivendo em países tropicais com características semelhantes.

Injuries due to fireworks use: A surveillance data analysis in Colombia, 2008-2013.

PURPOSE: To describe the injuries due to fireworks use in Colombia during the period 2008-2013 and to identify factors associated with hospitalization and death due to this cause. METHODS: A descriptive study from surveillance data was carried out. Incidence rates and relative risks were calculated. The incidence rate trend was modeled with a joint point regression model. Multivariate logistical models were implemented to identify the associated factors with hospitalization and mortality due to firework injuries. RESULTS: A total of 6585 people were reported to be injured by fireworks during the 2008-2013 period. An upward trend in the incidence rate during this period was observed, with an annual percentage of change of 28% (95% CI 27.7-28.3) during 2008-2011 and 3.5% (95% CI 3.0-3.9) during 2011-2013. The factors associated with hospitalization were injury occurrence at the workplace (odds ratio (OR) 2.62, 95% CI 1.97-3.47), storage (OR 2.40, 95% CI 1.54-3.73), transport (OR 1.63, 95% CI 1.20-2.21), multiple trauma (OR 1.49, 95% CI 1.31-1.70), and injury occurrence at home (OR 1.26, 95% CI 1.07-1.50). The factors associated with mortality were storage (OR 19.52, 95% CI 4.62-82.44), transport (OR 13.37, 95% CI 3.29-54.3), injury occurrence at the workplace (OR 4.88, 95% CI 1.69-14.13), and ethnicity (OR 3.37, 95% CI 1.12-10.12). CONCLUSION: These results provided information for revising the public policies and intersectorial interventions to reduce the avoidable burden due to firework injuries at all times and not just during the high injury occurrence season.

[Identification of knowledge about the quality of mortality information in Bogotá]. / Identificación de los conocimientos de calidad de la información de mortalidad en Bogotá.

OBJECTIVE: Identify the workers knowledge involved in the production and usage, about the quality of mortality information in Bogotá during 2006. METHODS: We conducted a descriptive study using a self-administered and semi-structured questionnaire in 130 functionaries who participated in the mortality data production and use. The instruments inquired into the reliability, characteristics, qualification, reasons for that qualification and improvement proposals. We calculated frequencies and percentage distributions. RESULTS: 76.2 % of respondents identified coverage and content as the aspects that best indicated reliability of mortality information. The main quality characteristics of the information recognized were veracity, 80.8 %; completeness, 76.2 %; accuracy, 75.4 %; opportunity, 74.6 %; and validity, 73.8 %. 55.4 % of participants rated the quality as fair and 6.2 % as poor. Some of the proposals for the quality improvement were awareness, training and evaluation processes. CONCLUSIONS: The findings suggest that there is still a lack of knowledge about the quality of mortality information in people involved in its production and use. It is necessary to correct this lack of knowledge by implementing the proposals to improve the quality of mortality data made by respondents. It is recommended that the various proposals that were exposed are monitored and evaluated to determine the impact they produce.

OBJETIVO: Identificar los conocimientos del personal que participaba en la producción y el uso de la información de mortalidad sobre la calidad de la misma, durante el año 2010. MÉTODOS: Estudio descriptivo que aplicó encuesta semi-estructurada, auto-administrada a 130 funcionarios que participaban en la producción y uso de estadísticas de mortalidad. Sobre los conocimientos de calidad de la información de mortalidad, se indagaron aspectos que daban cuenta de fiabilidad, características, calificación, explicación a la calificación dada y propuesta para mejorar. Se calcularon frecuencias y distribuciones porcentuales. RESULTADOS: El 76,2 % de los encuestados identificaron cobertura y contenido como aspectos que daban cuenta de la fiabilidad de la información de mortalidad. Las principales características de calidad de la información reconocidas fueron veracidad, 80,8 %; completitud, 76,2 %; precisión, 75,4 %; oportunidad, 74,6 %; y validez, 73,8 %. El 55,4 % de los participantes calificó la calidad como regular y el 6,2 % como mala. Sensibilización, procesos formativos y evaluativos fueron algunas de las propuestas mencionadas para el mejoramiento de la calidad. CONCLUSIONES: Los hallazgos sugieren que existe falta de conocimientos sobre la calidad de la información de mortalidad. Se hace necesario corregir esa falta de conocimientos poniendo en práctica las propuestas de mejoramiento realizada por los encuestados. Se recomendó que las distintas propuestas que se pongan en marcha, sean seguidas y evaluadas para conocer el impacto que ellas producen.

[Mortality by homicides in Colombia, 1998-2012].

INTRODUCTION: Homicide is a universal indicator of social violence with large public health consequences. OBJECTIVES: To describe mortality by homicides and to analyze its trends and geographic distribution in Colombia between 1998 and 2012. MATERIALS AND METHODS: We conducted a descriptive study of deaths by homicide in Colombia between 1998 and 2012 using official mortality databases and the population projections of the Departamento Administrativo Nacional de Estadística, DANE. We calculated age- and sex-specific mortality rates, and we analyzed the geographical distribution of mean-adjusted homicide mortality rates at municipal level. RESULTS: Between 1998 and 2012, 331,470 homicides were reported in Colombia. The mean crude rate was 51.5 per 100,000 inhabitants: 95.9 in men and 8.2 in women. Since 2003, a decrease in the number of deaths and rates was observed; 91.9% of the victims were men and the highest mortality rates were reported in the 20-29 years old group. The most frequently involved mechanism was the firearm: Eight of 10 homicides in men, and seven of 10 homicides in women. Out of 1,122 municipalities, 186 were in the highest quintile, accumulating 50.1% of all deaths. CONCLUSIONS: In Colombia, homicides have been one of the leading causes of death with a trend towards reduction since 2002. Its geographical distribution has been heterogeneous. To continue addressing this public health issue we must recur to multidisciplinary analytical methodologies for a better understanding of the phenomenon.

Mortalidad por homicidios en Colombia, 1998-2012 / Mortality by homicides in Colombia, 1998-2012

Resumen Introducción. El homicidio es un indicador universal de violencia social con grandes consecuencias en salud pública. Objetivo. Describir la mortalidad por homicidios, y analizar su tendencia y su distribución geográfica en Colombia entre 1998 y 2012. Materiales y métodos. Se hizo un estudio descriptivo basado en la información de las bases de datos sobre mortalidad y las proyecciones de población del Departamento Administrativo Nacional de Estadística, DANE. Se calcularon las tasas de mortalidad específica y ajustada por edad y sexo. Se analizó la distribución geográfica del promedio de tasas ajustadas a nivel municipal. Resultados. En Colombia se registraron 331.470 homicidios entre 1998 y 2012. La tasa cruda promedio fue de 51,5 por 100.000 habitantes: 95,9 en hombres y 8,2 en mujeres. A partir del 2003 se observó una disminución en el número de muertes y tasas de mortalidad. El 91,9 % de las víctimas fueron hombres. Las tasas de mortalidad más altas se observaron en el grupo de 20 a 29 años. El mecanismo más frecuentemente involucrado fue el arma de fuego: en ocho de cada diez homicidios en hombres y en siete de cada diez en mujeres. De los 1.122 municipios, 186 estaban en el quintil más alto y acumularon el 50,1 % de las defunciones. Conclusión. En Colombia los homicidios han sido una de las principales causas de muerte, con una distribución geográfica heterogénea y una tendencia hacia la reducción después de 2002. El análisis y la comprensión de este problema de salud pública exigen el uso de metodologías analíticas multidisciplinarias.

Abstract Introduction: Homicide is a universal indicator of social violence with large public health consequences. Objectives: To describe mortality by homicides and to analyze its trends and geographic distribution in Colombia between 1998 and 2012. Materials and methods: We conducted a descriptive study of deaths by homicide in Colombia between 1998 and 2012 using official mortality databases and the population projections of the Departamento Administrativo Nacional de Estadística, DANE. We calculated age- and sex-specific mortality rates, and we analyzed the geographical distribution of mean-adjusted homicide mortality rates at municipal level. Results: Between 1998 and 2012, 331,470 homicides were reported in Colombia. The mean crude rate was 51.5 per 100,000 inhabitants: 95.9 in men and 8.2 in women. Since 2003, a decrease in the number of deaths and rates was observed; 91.9% of the victims were men and the highest mortality rates were reported in the 20-29 years old group. The most frequently involved mechanism was the firearm: Eight of 10 homicides in men, and seven of 10 homicides in women. Out of 1,122 municipalities, 186 were in the highest quintile, accumulating 50.1% of all deaths. Conclusions: In Colombia, homicides have been one of the leading causes of death with a trend towards reduction since 2002. Its geographical distribution has been heterogeneous. To continue addressing this public health issue we must recur to multidisciplinary analytical methodologies for a better understanding of the phenomenon.

Dengue mortality in Colombia, 1985-2012.

INTRODUCTION: Dengue in Colombia is an important public health problem due to the huge economic and social costs it has caused, especially during the disease outbreaks.  OBJECTIVE: To describe the behavior of dengue mortality in Colombia between 1985 and 2012.  MATERIALS AND METHODS: We conducted a descriptive study. Information was obtained from mortality and population projection databases provided by the Departamento Administrativo Nacional de Estadística (DANE) for the 1985-2012 period. Mortality rates, rate ratios, and case fatality rates were estimated.  RESULTS: A total of 1,990 dengue deaths were registered during this period in Colombia. Dengue mortality rates presented an increasing trend with statistical significance between 1985 and 1998. Higher mortality rates were reported in men both younger than 5 years and older than 65 years. Between 1995 and 2012, category 1 to 4 municipalities reported the highest mortality rates. Case fatality rates varied during the period between 0.01% and 0.39%.  CONCLUSION: Dengue is an avoidable disease that should disappear from mortality statistics as a cause of death. The event is avoidable if the proposed activities from the Estrategia de Gestión Integrada (EGI)-Dengue are implemented and evaluated. We recommend encouraging the development of an informational culture to contribute to decision making and prioritizing resource allocation.