Características de la mortalidad por enfermedad diarreica aguda en población menor de cinco años registrada en el sistema de Vigilancia en Salud Pública, Colombia 2008 - 2016

Abstract

Introducción: La enfermedad diarreica es una de las principales causas de mortalidad y morbilidad en la niñez en el mundo. Más de la mitad de esas muertes prematuras se deben a enfermedades que se podrían evitar o tratar si hubiera acceso a intervenciones simples y asequibles. El objetivo de este estudio es identificar las características de la mortalidad por enfermedad diarreica aguda en menores de cinco años registrada en el Sistema de Vigilancia en Salud Pública (Sivigila) en el periodo 2008 – 2016 Metodología: Estudio descriptivo a partir de las bases de datos del Sistema de Vigilancia en Salud Pública (Sivigila) para el periodo 2008 – 2016 del evento Mortalidad por enfermedad diarreica aguda en menores de cinco años (Código 590). Se estimó los cambios de tendencia observada a lo largo del periodo de estudio mediante regresión de Jointpoint y el cambio de tendencia por entidad territorial a partir del promedio histórico de la tasa de incidencia y su comparación con la incidencia observada para el 2016. Para identificar algunos determinantes sociales y ambientales se utilizaron las variables consignadas en los datos complementarios. Resultados: se observa una reducción del 6% en la mortalidad por EDA en Colombia. En el 67 % de las entidades territoriales se observa una reducción en la incidencia respecto al promedio histórico, sin embargo, aquellas ubicadas a la periferia (Amazonía, Orinoquía, Pacífico y Norte del País), muestran de un comportamiento estacionario con tendencia al aumento. Se identificó en la mayor proporción de los casos no reconocimiento de signos de alarma y bajo nivel escolaridad del padre o cuidador, no inicio de sales de rehidratación oral que los menores no contaban con esquema de vacunación vigente para la edad, antecedente de desnutrición, falta de acceso a acueducto y alcantarillado, hacinamiento entre otros, lo cual permite identificar determinantes sociales y ambientales relacionados con el comportamiento del evento. Conclusiones: La mortalidad por EDA en menores de cinco años en el país ha mostrado una tendencia hacia la disminución, pero se observan diferencias y tendencia al aumento principalmente en los departamentos ubicados en la Amazonía y Orinoquía, región pacífica y norte del país.

Epidemiology of Snake Bites Linked with the Antivenoms Production in Colombia 2008–2020: Produced Vials Do Not Meet the Needs

“…The deaths and sequelae rate derived from this type of accident ranged between 0.04% and 7.6%, and between 5% and 9% respectively, being limb loss the worst sequel occurring in the 6.3% of the accidents. 28 , 34 , 40–42 These findings were very similar to the reported by Leon-Nuñez et al 6 for the period 2008–2016 in Colombia. The decrease in the severity of the accidents may be associated with an increase in the antivenom provided to treat each classified envenomation, as explained below.…”

“…Considering the classification of the severity of the accident, the SIVIGILA figures showed that an average of 26.4%, 12.5%, and 10.5% of the mild, moderate and severe classified accidents respectively did not receive antivenoms ( Table 1 ). 28 , 34 , 40–42 , 51 A decrease in the number of patients that did not receive any antivenom was detected in the figures from Leon-Nuñez et al 6 for the period 2008–2016 in Colombia. Despite this decrease, the fact that envenomed patients still not receiving the specific treatment is especially concerning, and place people at a high risk of sequels or death, as supported by Otero et al 37 After using antivenoms, adverse reactions were reported in 7.5% of the individuals.…”

“…According to the INS epidemiological reports, this rise can be explained by two aspects: 1) an increase in the registration and reporting of the snakebites derived from the awareness and training processes of health staff; 2) climatic factors corresponding mainly to rainy seasons and/or droughts. 28 The first aspect is most likely to be considered as the best explanation for the increased figures, as supported by Chippaux and Leon-Nuñez et al 6 , 29 However, the second should be reconsidered as a direct explanation for such a rapid and marked rise of snakebite envenomation in Colombia due to the lack of experimental data to support the statement. In fact, Chippaux 29 did not find any correlation between the annual incidence of snakebites and the average seasonal incidence between 2009 and 2014 in Colombia.…”

“…Despite this, only 58.5% of injured patients receive medical care including hospitalization, which is below the national goal of 100% according to the official guidelines. 26 , 28 , 34 , 40–43 Hospitals should provide specific treatment according to the level of severity. Considering the neutralizing capacity of the differente antivenoms, produced by the official manufacturer (National Health Institute) or imported, the official guideline on the management of envenomation stipulate that 8, 11 and 19 vials should be used to treat mild, moderate and severe snake envenomation respectively.…”

“…39 , 46 These two ethnic groups are commonly affected by snakebite accidents, representing 18% of the accidents (>790 individuals) per year. 21 , 28 , 34 , 40–42 , 45 , 47–51 Most of the population inhabiting rural areas is not affiliated to the SGSSS or belongs to the public regime, 52 explaining thus the high rate of the population affected by snakebites not affiliated to the SGSSS or affiliated to the public system.…”