RESUMO
In Colombia, approximately 105,000 suspected cases of Zika virus disease (diagnosed based on clinical symptoms, regardless of laboratory confirmation) were reported during August 9, 2015-November 12, 2016, including nearly 20,000 in pregnant women (1,2). Zika virus infection during pregnancy is a known cause of microcephaly and serious congenital brain abnormalities and has been associated with other birth defects related to central nervous system damage (3). Colombia's Instituto Nacional de Salud (INS) maintains national surveillance for birth defects, including microcephaly and other central nervous system defects. This report provides preliminary information on cases of congenital microcephaly identified in Colombia during epidemiologic weeks 5-45 (January 31-November 12) in 2016. During this period, 476 cases of microcephaly were reported, compared with 110 cases reported during the same period in 2015. The temporal association between reported Zika virus infections and the occurrence of microcephaly, with the peak number of reported microcephaly cases occurring approximately 24 weeks after the peak of the Zika virus disease outbreak, provides evidence suggesting that the period of highest risk is during the first trimester of pregnancy and early in the second trimester of pregnancy. Microcephaly prevalence increased more than fourfold overall during the study period, from 2.1 per 10,000 live births in 2015 to 9.6 in 2016. Ongoing population-based birth defects surveillance is essential for monitoring the impact of Zika virus infection during pregnancy on birth defects prevalence and measuring the success in preventing Zika virus infection and its consequences, including microcephaly.
Assuntos
Microcefalia/epidemiologia , Complicações Infecciosas na Gravidez/epidemiologia , Infecção por Zika virus/epidemiologia , Colômbia/epidemiologia , Feminino , Humanos , Lactente , Recém-Nascido , GravidezRESUMO
Background. In Colombia, maternal near miss morbidity is monitored in the health surveillance system. The National Health Institute included a special report on cases that met three or more World Health Organization criteria according to the World Health Organization criteria. Objective. To estimate the relationship between variables related to opportune access to health care services in Colombia during 2013 depending on inclusion criteria -three or more- for maternal near miss morbidity. Materials and methods. A cross-sectional analysis of the national registry of obligatory notification on maternal near miss morbidity was performed. Cases with three or more criteria were compared with those with one or two according to some variables related to the timely access of health care services. Results. A total of 8 434 maternal near miss morbidity cases were reported, women were aged between 12 and 51 years old (M=26.4, SD=7.5). 961 (11.4%) lived in remote rural areas; 4 537 (53.8%) were uninsured under the health system, or they were affiliated to either the subsidized or special health care regime; 845 (10.0%) belonged to an ethnic minority; 3 696 (44.4%) were referred to a more complex service; 4 097 (49.2%) were admitted to the intensive care unit; and 3 975 (47.1%) met three or more of the inclusion criteria for maternal near miss morbidity. They were combined to meet three or more of the case inclusion criteria: intensive care unit admission (OR=5.58; IC95% 5.06-6.15); being uninsured or affiliated to the subsidized or special regime (OR=1.57; IC95% 1.42-1.74); and referral to a more complex service (OR=1.18; IC95% 1.07-1.31). Conclusions. In Colombia, the timely access of health care services is related to maternal near miss morbidity with three or more inclusion criteria.
Antecedentes. En Colombia, la morbilidad materna extrema es monitoreada en el sistema de vigilancia epidemiológica. El Instituto Nacional de Salud incluyó el análisis particular de los casos que reunieran tres o más criterios de inclusión de definición de caso. Objetivo. Estimar la relación entre variables relacionadas con el acceso oportuno a la prestación de los servicios en salud y los criterios de inclusión -tres o más- para morbilidad materna extrema en Colombia durante 2013. Materiales y métodos. Se realizó un análisis transversal del registro nacional de notificación obligatoria sobre morbilidad materna extrema; los casos con tres criterios o más se compararon con aquellos con uno o dos según algunas variables relacionadas con el acceso oportuno a la prestación de servicios en salud. Resultados. Se notificaron 8.434 casos de morbilidad materna extrema, edades entre 12 y 51 años (M=26.4; DE=7.5). 961 (11.4%) residentes en zona rural remota, 4.537 (53.8%) en régimen no asegurado, subsidiado o especial, 845 (10.0%) pertenecientes a minoría étnica, 3.696 (44.4%) fueron remitidas a un servicio de mayor complejidad, 4.097 (49.2%) recibieron servicios en unidad de cuidados intensivos y 3.975 (47.1%) reunieron tres o más criterios de inclusión de caso morbilidad materna extrema. Se asociaron a reunir tres o más criterios de inclusión de caso: el ingreso a unidad de cuidados intensivos (OR=5.58; IC95% 5.06-6.15), régimen no asegurado, subsidiado o especial (OR=1.57; IC95% 1.42-1.74) y remisión a servicio de mayor complejidad (OR=1.18; IC95% 1.07-1.31). Conclusiones. En Colombia, el acceso oportuno a los servicios de atención en salud se relaciona con morbilidad materna extrema de tres o más criterios de inclusión.