Analysis of interactions of actors of the knowledge network on malaria in Colombia / Análisis de interacciones de actores de la red de gestión del conocimiento en malaria de Colombia

Introduction: Malaria is a disease with a high impact on Colombian population, which must be approached from the point of view of teamwork of institutions for knowledge exchange. Objective: To analyze the interactions of the Red de Gestión del Conocimiento, Investigación e Innovación en Malaria de Colombia. Materials and methods: An analysis of social networks was applied that allowed identifying the proximity between actors and the degree of knowledge between them. Indicators of density, diameter, average distance, and degree of centrality were observed. The documentary corpus for the study consisted of 193 technical documents published between 2016 and 2021, which were analyzed using text mining using the R programming language. The network was categorized based on five variables: comprehensive patient care, diagnosis, epidemiology and health information analysis systems, public policy and promotion and prevention. Results: The analysis of interactions indicated that the network was made up by 99 actors. The main interest in knowledge production was on epidemiology and health information analysis systems (98 % of the actors), followed by the integral patient care (80 % of the actors). On the contrary, the least approached category was malaria promotion and prevention practices (54 % of the actors). Conclusions: In general, this study contributes to the strengthening of key strategies in the dissemination of knowledge about malaria in Colombia.

Introducción. La malaria, o paludismo, es una enfermedad de gran impacto en la población colombiana, que debe ser abordada desde el punto de vista del trabajo en equipo de instituciones para el intercambio de conocimiento. Objetivo. Analizar las interacciones de la Red de Gestión del Conocimiento, Investigación e Innovación en Malaria de Colombia. Materiales y métodos. Se hizo un análisis de redes sociales que permitió identificar la proximidad entre los actores y el grado de conocimiento entre ellos; se observaron indicadores de densidad, diámetro, distancia media y centralidad de grado. El corpus documental para el estudio estuvo constituido por 193 documentos técnicos publicados entre el 2016 y el 2021, que fueron analizados empleando técnicas de procesamiento de texto mediante el lenguaje de programación R. La categorización de la red se realizó a partir de cinco variables: atención integral a pacientes, diagnóstico, epidemiología y sistemas de análisis de información en salud, política pública, y promoción y prevención. Resultados. El análisis de las interacciones indicó que la red la conformaban 99 actores, de los cuales 97 (98 %), mostraron más interés en la producción de conocimientos en epidemiología y sistemas de análisis de información en salud, seguido de la categoría de atención integral a pacientes con 79 (80 %). El 54 % de los actores llevó a cabo estudios de promoción y prevención, siendo esta la categoría de menor abordaje. Conclusiones. Este estudio contribuye al fortalecimiento de estrategias clave en la divulgación del conocimiento sobre la malaria en Colombia.

Trade-offs between individual and ensemble forecasts of an emerging infectious disease.

Probabilistic forecasts play an indispensable role in answering questions about the spread of newly emerged pathogens. However, uncertainties about the epidemiology of emerging pathogens can make it difficult to choose among alternative model structures and assumptions. To assess the potential for uncertainties about emerging pathogens to affect forecasts of their spread, we evaluated the performance 16 forecasting models in the context of the 2015-2016 Zika epidemic in Colombia. Each model featured a different combination of assumptions about human mobility, spatiotemporal variation in transmission potential, and the number of virus introductions. We found that which model assumptions had the most ensemble weight changed through time. We additionally identified a trade-off whereby some individual models outperformed ensemble models early in the epidemic, but on average the ensembles outperformed all individual models. Our results suggest that multiple models spanning uncertainty across alternative assumptions are necessary to obtain robust forecasts for emerging infectious diseases.

Global, Regional, and Country-Specific Lifetime Risks of Stroke, 1990 and 2016.

BACKGROUND: The lifetime risk of stroke has been calculated in a limited number of selected populations. We sought to estimate the lifetime risk of stroke at the regional, country, and global level using data from a comprehensive study of the prevalence of major diseases. METHODS: We used the Global Burden of Disease (GBD) Study 2016 estimates of stroke incidence and the competing risks of death from any cause other than stroke to calculate the cumulative lifetime risks of first stroke, ischemic stroke, or hemorrhagic stroke among adults 25 years of age or older. Estimates of the lifetime risks in the years 1990 and 2016 were compared. Countries were categorized into quintiles of the sociodemographic index (SDI) used in the GBD Study, and the risks were compared across quintiles. Comparisons were made with the use of point estimates and uncertainty intervals representing the 2.5th and 97.5th percentiles around the estimate. RESULTS: The estimated global lifetime risk of stroke from the age of 25 years onward was 24.9% (95% uncertainty interval, 23.5 to 26.2); the risk among men was 24.7% (95% uncertainty interval, 23.3 to 26.0), and the risk among women was 25.1% (95% uncertainty interval, 23.7 to 26.5). The risk of ischemic stroke was 18.3%, and the risk of hemorrhagic stroke was 8.2%. In high-SDI, high-middle-SDI, and low-SDI countries, the estimated lifetime risk of stroke was 23.5%, 31.1% (highest risk), and 13.2% (lowest risk), respectively; the 95% uncertainty intervals did not overlap between these categories. The highest estimated lifetime risks of stroke according to GBD region were in East Asia (38.8%), Central Europe (31.7%), and Eastern Europe (31.6%), and the lowest risk was in eastern sub-Saharan Africa (11.8%). The mean global lifetime risk of stroke increased from 22.8% in 1990 to 24.9% in 2016, a relative increase of 8.9% (95% uncertainty interval, 6.2 to 11.5); the competing risk of death from any cause other than stroke was considered in this calculation. CONCLUSIONS: In 2016, the global lifetime risk of stroke from the age of 25 years onward was approximately 25% among both men and women. There was geographic variation in the lifetime risk of stroke, with the highest risks in East Asia, Central Europe, and Eastern Europe. (Funded by the Bill and Melinda Gates Foundation.).

Global Mortality From Firearms, 1990-2016.

Importance: Understanding global variation in firearm mortality rates could guide prevention policies and interventions. Objective: To estimate mortality due to firearm injury deaths from 1990 to 2016 in 195 countries and territories. Design, Setting, and Participants: This study used deidentified aggregated data including 13 812 location-years of vital registration data to generate estimates of levels and rates of death by age-sex-year-location. The proportion of suicides in which a firearm was the lethal means was combined with an estimate of per capita gun ownership in a revised proxy measure used to evaluate the relationship between availability or access to firearms and firearm injury deaths. Exposures: Firearm ownership and access. Main Outcomes and Measures: Cause-specific deaths by age, sex, location, and year. Results: Worldwide, it was estimated that 251 000 (95% uncertainty interval [UI], 195 000-276 000) people died from firearm injuries in 2016, with 6 countries (Brazil, United States, Mexico, Colombia, Venezuela, and Guatemala) accounting for 50.5% (95% UI, 42.2%-54.8%) of those deaths. In 1990, there were an estimated 209 000 (95% UI, 172 000 to 235 000) deaths from firearm injuries. Globally, the majority of firearm injury deaths in 2016 were homicides (64.0% [95% UI, 54.2%-68.0%]; absolute value, 161 000 deaths [95% UI, 107 000-182 000]); additionally, 27% were firearm suicide deaths (67 500 [95% UI, 55 400-84 100]) and 9% were unintentional firearm deaths (23 000 [95% UI, 18 200-24 800]). From 1990 to 2016, there was no significant decrease in the estimated global age-standardized firearm homicide rate (-0.2% [95% UI, -0.8% to 0.2%]). Firearm suicide rates decreased globally at an annualized rate of 1.6% (95% UI, 1.1-2.0), but in 124 of 195 countries and territories included in this study, these levels were either constant or significant increases were estimated. There was an annualized decrease of 0.9% (95% UI, 0.5%-1.3%) in the global rate of age-standardized firearm deaths from 1990 to 2016. Aggregate firearm injury deaths in 2016 were highest among persons aged 20 to 24 years (for men, an estimated 34 700 deaths [95% UI, 24 900-39 700] and for women, an estimated 3580 deaths [95% UI, 2810-4210]). Estimates of the number of firearms by country were associated with higher rates of firearm suicide (P < .001; R2 = 0.21) and homicide (P < .001; R2 = 0.35). Conclusions and Relevance: This study estimated between 195 000 and 276 000 firearm injury deaths globally in 2016, the majority of which were firearm homicides. Despite an overall decrease in rates of firearm injury death since 1990, there was variation among countries and across demographic subgroups.

Global, Regional, and National Cancer Incidence, Mortality, Years of Life Lost, Years Lived With Disability, and Disability-Adjusted Life-Years for 29 Cancer Groups, 1990 to 2016: A Systematic Analysis for the Global Burden of Disease Study.

Importance: The increasing burden due to cancer and other noncommunicable diseases poses a threat to human development, which has resulted in global political commitments reflected in the Sustainable Development Goals as well as the World Health Organization (WHO) Global Action Plan on Non-Communicable Diseases. To determine if these commitments have resulted in improved cancer control, quantitative assessments of the cancer burden are required. Objective: To assess the burden for 29 cancer groups over time to provide a framework for policy discussion, resource allocation, and research focus. Evidence Review: Cancer incidence, mortality, years lived with disability, years of life lost, and disability-adjusted life-years (DALYs) were evaluated for 195 countries and territories by age and sex using the Global Burden of Disease study estimation methods. Levels and trends were analyzed over time, as well as by the Sociodemographic Index (SDI). Changes in incident cases were categorized by changes due to epidemiological vs demographic transition. Findings: In 2016, there were 17.2 million cancer cases worldwide and 8.9 million deaths. Cancer cases increased by 28% between 2006 and 2016. The smallest increase was seen in high SDI countries. Globally, population aging contributed 17%; population growth, 12%; and changes in age-specific rates, -1% to this change. The most common incident cancer globally for men was prostate cancer (1.4 million cases). The leading cause of cancer deaths and DALYs was tracheal, bronchus, and lung cancer (1.2 million deaths and 25.4 million DALYs). For women, the most common incident cancer and the leading cause of cancer deaths and DALYs was breast cancer (1.7 million incident cases, 535 000 deaths, and 14.9 million DALYs). In 2016, cancer caused 213.2 million DALYs globally for both sexes combined. Between 2006 and 2016, the average annual age-standardized incidence rates for all cancers combined increased in 130 of 195 countries or territories, and the average annual age-standardized death rates decreased within that timeframe in 143 of 195 countries or territories. Conclusions and Relevance: Large disparities exist between countries in cancer incidence, deaths, and associated disability. Scaling up cancer prevention and ensuring universal access to cancer care are required for health equity and to fulfill the global commitments for noncommunicable disease and cancer control.

Experiencias departamentales en la construcción, divulgación y uso del análisis de situación de salud, Colombia 2016 / Experiences in construction, dissemination and use of the health situation analysis in Colombia 2016

RESUMEN Objetivo El Análisis de Situación de Salud (ASIS) es una metodología que se encuentra en implementación recientemente en Colombia. Este estudio buscó comprender la experiencia de construcción, divulgación y uso del ASIS para la toma de decisiones en algunas entidades territoriales (ET). Métodos Entrevistas semiestructuradas a funcionarios de las entidades departamentales de salud; la información fue analizada de acuerdo a un conjunto de categorías establecidas previamente. Resultados Las ET implementan el ASIS incorporando el enfoque de los Determinantes Sociales de la Salud; sin embargo, las capacidades técnicas, económicas y humanas son desiguales para la elaboración de este tipo de análisis; la participación intersectorial y social aún es débil y los resultados generados todavía no orientan la toma de decisiones a nivel territorial. Conclusiones La metodología ASIS aspira a posicionarse como uno de los mecanismos oficiales para generar evidencia que oriente las políticas y la toma de decisiones en salud a nivel nacional, regional y local; existen desafíos a nivel económico, institucional y político para su consolidación como estrategia de útil en la planificación en salud. El ASIS es una metodología de gran relevancia para las ET y debe seguir fortaleciéndose su implementación.(AU)

ABSTRACT Objetive The Health Situation Analysis (ASIS in Spanish) is a methodology that has been implemented recently in Colombia. This study aims at understanding the experience of building, disseminating and using ASIS for decision-making in some territorial entities. Methods Semistructured interviews were applied to officials of the departmental health entities. The information was analyzed according to a set of categories previously established. Results The territorial entities implement ASIS by incorporating the Social Determinants of Health approach; however, the technical, economic and human capacities for the elaboration of this type of analysis are not equitable. Intersectoral and social participation is still weak and the results do not guide the decision making at territorial level yet. Conclusions The ASIS methodology seeks to position itself as one of the official mechanisms to generate evidence that guides health policy and decision making at national, regional and local levels. There are economic, institutional and political challenges for its consolidation as a useful strategy in health planning. ASIS is a methodology of great relevance for the territorial entities and its implementation should be further strengthened.(AU)

[Experiences in construction, dissemination and use of the health situation analysis in Colombia 2016]. / Experiencias departamentales en la construcción, divulgación y uso del análisis de situación de salud, Colombia 2016.

OBJETIVE: The Health Situation Analysis (ASIS in Spanish) is a methodology that has been implemented recently in Colombia. This study aims at understanding the experience of building, disseminating and using ASIS for decision-making in some territorial entities. METHODS: Semistructured interviews were applied to officials of the departmental health entities. The information was analyzed according to a set of categories previously established. RESULTS: The territorial entities implement ASIS by incorporating the Social Determinants of Health approach; however, the technical, economic and human capacities for the elaboration of this type of analysis are not equitable. Intersectoral and social participation is still weak and the results do not guide the decision making at territorial level yet. CONCLUSIONS: The ASIS methodology seeks to position itself as one of the official mechanisms to generate evidence that guides health policy and decision making at national, regional and local levels. There are economic, institutional and political challenges for its consolidation as a useful strategy in health planning. ASIS is a methodology of great relevance for the territorial entities and its implementation should be further strengthened.

OBJETIVO: El Análisis de Situación de Salud (ASIS) es una metodología que se encuentra en implementación recientemente en Colombia. Este estudio buscó comprender la experiencia de construcción, divulgación y uso del ASIS para la toma de decisiones en algunas entidades territoriales (ET). MÉTODOS: Entrevistas semiestructuradas a funcionarios de las entidades departamentales de salud; la información fue analizada de acuerdo a un conjunto de categorías establecidas previamente. RESULTADOS: Las ET implementan el ASIS incorporando el enfoque de los Determinantes Sociales de la Salud; sin embargo, las capacidades técnicas, económicas y humanas son desiguales para la elaboración de este tipo de análisis; la participación intersectorial y social aún es débil y los resultados generados todavía no orientan la toma de decisiones a nivel territorial. CONCLUSIONES: La metodología ASIS aspira a posicionarse como uno de los mecanismos oficiales para generar evidencia que oriente las políticas y la toma de decisiones en salud a nivel nacional, regional y local; existen desafíos a nivel económico, institucional y político para su consolidación como estrategia de útil en la planificación en salud. El ASIS es una metodología de gran relevancia para las ET y debe seguir fortaleciéndose su implementación.

The global burden of dengue: an analysis from the Global Burden of Disease Study 2013.

BACKGROUND: Dengue is the most common arbovirus infection globally, but its burden is poorly quantified. We estimated dengue mortality, incidence, and burden for the Global Burden of Disease Study 2013. METHODS: We modelled mortality from vital registration, verbal autopsy, and surveillance data using the Cause of Death Ensemble Modelling tool. We modelled incidence from officially reported cases, and adjusted our raw estimates for under-reporting based on published estimates of expansion factors. In total, we had 1780 country-years of mortality data from 130 countries, 1636 country-years of dengue case reports from 76 countries, and expansion factor estimates for 14 countries. FINDINGS: We estimated an average of 9221 dengue deaths per year between 1990 and 2013, increasing from a low of 8277 (95% uncertainty estimate 5353-10 649) in 1992, to a peak of 11 302 (6790-13 722) in 2010. This yielded a total of 576 900 (330 000-701 200) years of life lost to premature mortality attributable to dengue in 2013. The incidence of dengue increased greatly between 1990 and 2013, with the number of cases more than doubling every decade, from 8·3 million (3·3 million-17·2 million) apparent cases in 1990, to 58·4 million (23·6 million-121·9 million) apparent cases in 2013. When accounting for disability from moderate and severe acute dengue, and post-dengue chronic fatigue, 566 000 (186 000-1 415 000) years lived with disability were attributable to dengue in 2013. Considering fatal and non-fatal outcomes together, dengue was responsible for 1·14 million (0·73 million-1·98 million) disability-adjusted life-years in 2013. INTERPRETATION: Although lower than other estimates, our results offer more evidence that the true symptomatic incidence of dengue probably falls within the commonly cited range of 50 million to 100 million cases per year. Our mortality estimates are lower than those presented elsewhere and should be considered in light of the totality of evidence suggesting that dengue mortality might, in fact, be substantially higher. FUNDING: Bill & Melinda Gates Foundation.

Global and National Burden of Diseases and Injuries Among Children and Adolescents Between 1990 and 2013: Findings From the Global Burden of Disease 2013 Study.

IMPORTANCE: The literature focuses on mortality among children younger than 5 years. Comparable information on nonfatal health outcomes among these children and the fatal and nonfatal burden of diseases and injuries among older children and adolescents is scarce. OBJECTIVE: To determine levels and trends in the fatal and nonfatal burden of diseases and injuries among younger children (aged <5 years), older children (aged 5-9 years), and adolescents (aged 10-19 years) between 1990 and 2013 in 188 countries from the Global Burden of Disease (GBD) 2013 study. EVIDENCE REVIEW: Data from vital registration, verbal autopsy studies, maternal and child death surveillance, and other sources covering 14,244 site-years (ie, years of cause of death data by geography) from 1980 through 2013 were used to estimate cause-specific mortality. Data from 35,620 epidemiological sources were used to estimate the prevalence of the diseases and sequelae in the GBD 2013 study. Cause-specific mortality for most causes was estimated using the Cause of Death Ensemble Model strategy. For some infectious diseases (eg, HIV infection/AIDS, measles, hepatitis B) where the disease process is complex or the cause of death data were insufficient or unavailable, we used natural history models. For most nonfatal health outcomes, DisMod-MR 2.0, a Bayesian metaregression tool, was used to meta-analyze the epidemiological data to generate prevalence estimates. FINDINGS: Of the 7.7 (95% uncertainty interval [UI], 7.4-8.1) million deaths among children and adolescents globally in 2013, 6.28 million occurred among younger children, 0.48 million among older children, and 0.97 million among adolescents. In 2013, the leading causes of death were lower respiratory tract infections among younger children (905.059 deaths; 95% UI, 810,304-998,125), diarrheal diseases among older children (38,325 deaths; 95% UI, 30,365-47,678), and road injuries among adolescents (115,186 deaths; 95% UI, 105,185-124,870). Iron deficiency anemia was the leading cause of years lived with disability among children and adolescents, affecting 619 (95% UI, 618-621) million in 2013. Large between-country variations exist in mortality from leading causes among children and adolescents. Countries with rapid declines in all-cause mortality between 1990 and 2013 also experienced large declines in most leading causes of death, whereas countries with the slowest declines had stagnant or increasing trends in the leading causes of death. In 2013, Nigeria had a 12% global share of deaths from lower respiratory tract infections and a 38% global share of deaths from malaria. India had 33% of the world's deaths from neonatal encephalopathy. Half of the world's diarrheal deaths among children and adolescents occurred in just 5 countries: India, Democratic Republic of the Congo, Pakistan, Nigeria, and Ethiopia. CONCLUSIONS AND RELEVANCE: Understanding the levels and trends of the leading causes of death and disability among children and adolescents is critical to guide investment and inform policies. Monitoring these trends over time is also key to understanding where interventions are having an impact. Proven interventions exist to prevent or treat the leading causes of unnecessary death and disability among children and adolescents. The findings presented here show that these are underused and give guidance to policy makers in countries where more attention is needed.

Costo efectividad de la vacunación contra influenza en menores de 2 años y mayores de 65 años en Colombia / Cost effectiveness of influenza vaccination in children under 2 years old and elderly in Colombia

Objetivo: Estimar la carga de enfermedad asociada a influenza y modelar el impacto epidemiológico y económico de la introducción de la vacuna para influenza en Colombia. Métodos: Se realizó un estudio de evaluación económica completa de la introducción de la vacuna de influenza en dos grupos poblacionales. Los desenlaces seleccionados en menores de dos años fueron la frecuencia de enfermedad respiratoria (ERA), consultas y hospitalizaciones por ERA. En mayores de 65 años se adicionaron las muertes y hospitalizaciones por enfermedad cardiosvascular y cerebrovascular. Resultados: En el escenario sin vacunación, el virus de influenza produciría anualmente 4 300 casos, 2 700 consultas, 900 hospitalizaciones y 230 muertes por ERA en menores de dos años. En mayores de 65 años, se presentarían anualmente 670 muertes por neumonía, 1 150 muertes por enfermedad cardiovascular y 720 muertes por enfermedad cerebrovascular relacionadas con influenza. El costo efectividad de la vacuna en menores de dos años oscila entre US $ 1 900 y US $ 2 967 por muerte evitada mientras que para mayores de 65 años la razón de costo efectividad seria costo ahorrativa. Conclusiones: Los resultados del presente estudio apoyarían la decisión del Ministerio de la Protección Social y algunas Secretarias de Salud de introducir la vacunación en Colombia para menores de dos años y mayores de 65 años.

Objective Estimating the burden of disease associated with influenza virus season and modelling the epidemiological and economic impacts of introducing an inactivated vaccine to Colombia. Methodology A complete economic evaluation was done in children aged less than 2 and adults aged over 65. The outcomes evaluated in the under 2-year olds included: the yearly number of cases of acute respiratory infection (ARI), medical visits, hospitalisations and deaths by ARI. The outcomes measured in adults were the number of yearly deaths and hospitalisations due to cardiocirculatory diseases (CCD). Results Influenza infection in children under 2 years old not having had vaccination may cause 4,300 cases, 2,700 medical visits, 900 hospitalisations and 230 deaths by ARI yearly. Amongst the elder group, influenza infection would be associated with 670 deaths by pneumonia and 1,870 deaths from CCD. The incremental cost effectiveness ratio (ICER) for flu vaccination among children under 2 ranged from USD$ 1,900 to USD$ 2,967 per averted death. ICER was cost saving in adults aged over 65. Conclusions This study's results supported the Colombian Ministry of Health's initiative for introducing yearly flu vaccination amongst small children and older adults in Colombia.

[Cost effectiveness of influenza vaccination in children under 2 years old and elderly in Colombia]. / Costo efectividad de la vacunación contra influenza en menores de 2 años y mayores de 65 años en Colombia.

OBJECTIVE: Estimating the burden of disease associated with influenza virus season and modelling the epidemiological and economic impacts of introducing an inactivated vaccine to Colombia. METHODOLOGY: A complete economic evaluation was done in children aged less than 2 and adults aged over 65. The outcomes evaluated in the under 2-year olds included: the yearly number of cases of acute respiratory infection (ARI), medical visits, hospitalisations and deaths by ARI. The outcomes measured in adults were the number of yearly deaths and hospitalisations due to cardiocirculatory diseases (CCD). RESULTS: Influenza infection in children under 2 years old not having had vaccination may cause 4,300 cases, 2,700 medical visits, 900 hospitalisations and 230 deaths by ARI yearly. Amongst the elder group, influenza infection would be associated with 670 deaths by pneumonia and 1,870 deaths from CCD. The incremental cost effectiveness ratio (ICER) for flu vaccination among children under 2 ranged from USD$ 1,900 to USD$ 2,967 per averted death. ICER was cost saving in adults aged over 65. CONCLUSIONS: This study's results supported the Colombian Ministry of Health's initiative for introducing yearly flu vaccination amongst small children and older adults in Colombia.