Changes in birth outcomes and utilization of prenatal care during the COVID-19 pandemic in 2020: a secondary analysis of vital statistics in Colombia.

BACKGROUND: Birth outcomes could have been affected by the COVID-19 pandemic through changes in access to prenatal services and other pathways. The aim of this study was to examine the effects of the COVID-19 pandemic on fetal death, birth weight, gestational age, number of prenatal visits, and caesarean delivery in 2020 in Colombia. METHODS: We conducted a secondary analysis of data on 3,140,010 pregnancies and 2,993,534 live births from population-based birth certificate and fetal death certificate records in Colombia between 2016 and 2020. Outcomes were compared separately for each month during 2020 with the same month in 2019 and pre-pandemic trends were examined in regression models controlling for maternal age, educational level, marital status, type of health insurance, place of residence (urban/rural), municipality of birth, and the number of pregnancies the mother has had before last pregnancy. RESULTS: We found some evidence for a decline in miscarriage risk in some months after the pandemic start, while there was an apparent lagging increase in stillbirth risk, although not statistically significant after correction for multiple comparisons. Birth weight increased during the onset of the pandemic, a change that does not appear to be driven by pre-pandemic trends. Specifically, mean birth weight was higher in 2020 than 2019 for births in April through December by about 12 to 21 g (p < 0.01). There was also a lower risk of gestational age at/below 37 weeks in 2020 for two months following the pandemic (April, June), but a higher risk in October. Finally, there was a decline in prenatal visits in 2020 especially in June-October, but no evidence of a change in C-section delivery. CONCLUSIONS: The study findings suggest mixed early effects of the pandemic on perinatal outcomes and prenatal care utilization in Colombia. While there was a significant decline in prenatal visits, other factors may have had counter effects on perinatal health including an increase in birth weight on average.

Effect of bloodstream infection on survival in COVID-19 patients admitted to an intensive care unit in Colombia: a matched cohort analysis.

Aim: To determine the impact of bloodstream infection (BSI) and other risk factors for mortality in patients with COVID-19 admitted to the intensive care unit (ICU). Methods: A retrospective cohort was carried out at the Hospital Universitario Nacional (HUN) between March 29 and December 19, 2020. Patients with COVID-19 admitted to the Intensive Care Unit (ICU) were paired 1:4 in two groups, one with BSI and the other without, according to hospital stay and the month of admission. The primary outcome was mortality at 28 days. A Cox proportional hazards model was used to estimate differences in mortality risk. Results: 456 patients were identified and 320 were included in the final cohort, 18% (n = 59) in the BSI group and 82% (n = 261) in the control group. 125 (39%) patients died, 30 (51%) in the BSI group and 95 (36%) in the control group (P = 0.040). BSI was associated with an increased risk of in-hospital mortality at 28 days, [HR] 1.77 (95% CI: 1.03-3.02; P = 0.037). Invasive mechanical ventilation (IMV) and age were associated with increased mortality risk. Some months of the year of the hospital stay were associated with a reduced risk of mortality. There was no difference in mortality between inappropriate and appropriate empirical antimicrobial use. Conclusion: BSI in patients with COVID-19 in ICU increases in-hospital mortality to 28 days. Other risk factors for mortality were IMV and age.

Understanding how socioeconomic inequalities drive inequalities in COVID-19 infections.

Across the world, the COVID-19 pandemic has disproportionately affected economically disadvantaged groups. This differential impact has numerous possible explanations, each with significantly different policy implications. We examine, for the first time in a low- or middle-income country, which mechanisms best explain the disproportionate impact of the virus on the poor. Combining an epidemiological model with rich data from Bogotá, Colombia, we show that total infections and inequalities in infections are largely driven by inequalities in the ability to work remotely and in within-home secondary attack rates. Inequalities in isolation behavior are less important but non-negligible, while access to testing and contract-tracing plays practically no role because it is too slow to contain the virus. Interventions that mitigate transmission are often more effective when targeted on socioeconomically disadvantaged groups.

COVID-19 spread, detection, and dynamics in Bogota, Colombia.

Latin America has been severely affected by the COVID-19 pandemic but estimations of rates of infections are very limited and lack the level of detail required to guide policy decisions. We implemented a COVID-19 sentinel surveillance study with 59,770 RT-PCR tests on mostly asymptomatic individuals and combine this data with administrative records on all detected cases to capture the spread and dynamics of the COVID-19 pandemic in Bogota from June 2020 to early March 2021. We describe various features of the pandemic that appear to be specific to a middle income countries. We find that, by March 2021, slightly more than half of the population in Bogota has been infected, despite only a small fraction of this population being detected. The initial buildup of immunity contributed to the containment of the pandemic in the first and second waves. We also show that the share of the population infected by March 2021 varies widely by occupation, socio-economic stratum, and location. This, in turn, has affected the dynamics of the spread with different groups being infected in the two waves.