Impact of the COVID-19 pandemic on routine childhood immunisation in Colombia.

OBJECTIVE: To assess the impact of the COVID-19 pandemic on routine childhood vaccination coverage in Colombia by age group, rural/urban residence, state and vaccine type. DESIGN: Ecological study of official monthly vaccination records. SETTING: Vaccination records from the Colombian Ministry of Health (March-October 2019 and 2020). PARTICIPANTS: Aggregated data for Colombian children (<12 months, n=676 153; 12-23 months, n=700 319; and 5 years, n=734 295) participating in the Expanded Program on Immunization. MAIN OUTCOME MEASURES: Proportion of eligible population receiving vaccination. RESULTS: Vaccination coverage showed an overall decline of approximately 14.4% from 2019 to 2020 (2019 coverage=76.0, 2020 coverage=61.6%). The greatest reduction in proportion vaccinated was observed in children <12 months of age for pneumococcal vaccine (second dose) (2019 coverage=81.4%; 2020 coverage=62.2%; 2019-2020 absolute difference, 19.2%; 95% CI 14.8% to 23.7%). For children aged 12-23 months, the proportion vaccinated for yellow fever declined by 16.4% (12.4% to 20.9%) from 78.3% in 2019 to 61.8% in 2020. Among children 5 years of age, the biggest decrease occurred for the oral polio vaccine (second dose), with a difference of 11.4% (7.1% to 15.7%) between 2019 and 2020 (73.1% and 61.7% for 2019 and 2020). We observed a statistically significant effect on vaccine coverage in rural versus urban areas for children <12 months and 5 years of age. CONCLUSIONS: Reduced uptake of immunisations during the COVID-19 pandemic poses a serious risk of vaccine-preventable disease outbreaks. Colombia and other middle-income countries need to continue to monitor immunisation programme coverage and disease outbreaks at the national and subnational levels and undertake catch-up vaccination activities.

Socioeconomic variation of multimorbidity in Colombian older adults.

Multimorbidity (MM) prevalence among older adults is increasing worldwide. Variations regarding the socioeconomic characteristics of the individuals and their context have been described, mostly in high-income settings. However, further research is needed to understand the effect of the coexistence of infectious diseases along with socioeconomic factors regarding MM. This study aims to examine the variation of MM regarding infectious diseases mortality after adjusting for socioeconomic factors. A cross-sectional multilevel study with a nationally representative sample of 17,571 Colombian adults of 60 years of age or older was conducted. Individual socioeconomic, demographic, childhood and health related characteristics, as well as group level variables (multidimensional poverty index and infectious diseases mortality rate) were analyzed. A two-level stepwise structural equation model was used to simultaneously adjust for the individual and contextual effects. Multimorbidity prevalence was 62.3% (95% CI 61.7-62.9). In the multilevel adjusted models, age, female sex, having functional limitations, non-white ethnicity, high body mass index, higher income, physical inactivity and living in urban areas were associated with multimorbidity among the sample for this study. The median odds ratio for multidimensional poverty was 1.18 (1.16-1.19; p = 0.008) and for infectious diseases was 1.25 (1.22-1.28; p = 0.014). This paper demonstrates that MM varies regarding the mortality of infectious diseases and shows a strong association between MM and poverty in a low-middle income country. Differences in the factors involved in the etiology of multimorbidity are expected among wealthy and poor countries regarding availability and prioritization of health services.

No inferioridad entre dos agentes de bajo volumen (picosulfato de sodio/citrato de magnesio frente al sulfato de sodio/potasio/magnesio) en la preparación del colon para procedimientos diagnósticos: estudio observacional / Non-inferiority between two low-volume agents (sodium picosulfate/magnesium citrate vs. sodium sulfate/potassium/magnesium) to prepare the bowel for diagnostic procedures: an observational study

Resumen Introducción: el cáncer colorrectal es un problema de salud pública; sin embargo, la detección temprana reduce su morbimortalidad. La colonoscopia es el procedimiento de elección para detectar lesiones premalignas y el éxito depende de una limpieza adecuada. El objetivo es evaluar el desempeño de dos preparaciones de bajo volumen empleados en un hospital de alto nivel. Materiales y métodos: estudio prospectivo en adultos que asistieran a colonoscopia en la Fundación Santa Fe de Bogotá, Colombia. Las preparaciones se evaluaron con la escala de Boston, con puntaje ≥ 6 puntos para una limpieza adecuada. Se realizó un análisis de regresión logística para establecer la efectividad de los medicamentos con un cálculo de no inferioridad del 3 %-5 %. Resultados: 598 pacientes fueron evaluados. El 49 % (293) fue expuesto al picosulfato de sodio/citrato de magnesio y el 51 % (305) fue expuesto al sulfato de sodio/potasio/magnesio. Con un promedio de Boston de 6,98 ± 1,86 (78 % con puntaje de Boston ≥ 6) y 7,39 ± 1,83 (83 %), respectivamente (p = 0,649). Según el análisis de la presencia y frecuencia de síntomas no deseados, el picosulfato fue mejor tolerado (p < 0,001). Conclusiones: los estudios de preparación intestinal en pacientes de un escenario real son muy escasos. Los medicamentos de bajo volumen obtuvieron una efectividad global y por segmento de colon similar, confirmando la no-inferioridad; el picosulfato de sodio/citrato de magnesio fue mejor tolerado. Un estudio de costo-efectividad podría definir esto según las necesidades de la población de estudio.

Abstract Introduction: Colorectal cancer is a public health problem; however, early detection reduces morbidity and mortality. Colonoscopy is the procedure of choice for detecting precancerous lesions, and success depends on proper bowel cleansing. Objective: To evaluate the performance of two low-volume agents used in a high-level hospital. Materials and methods: Prospective study in adults who underwent colonoscopy at the Fundación Santa Fe in Bogotá, Colombia. Preparations were evaluated using the Boston Bowel Preparation Scale. A score ≥6 points indicated adequate preparation. A logistic regression analysis was carried out to establish the effectiveness of the medicines with a non-inferiority ratio of 3-5%. Results: 598 patients were evaluated. 49% (293) received sodium picosulfate/magnesium citrate and 51% (305) received sodium sulfate/potassium/magnesium, with an average Boston score of 6.98±1.86 (78% Boston ≥6) and 7.39±1.83 (83%), respectively (p=0.649). According to the analysis of the presence and frequency of unwanted symptoms, picosulfate was better tolerated (p < 0.001). Conclusions: Bowel preparation studies in patients from a real-life scenario are scarce. Low-volume agents had similar overall and segmental effectiveness in the colon, confirming non-inferiority; sodium picosulfate/magnesium citrate was better tolerated. A cost-effectiveness study could establish the best option according to the needs of the study population.