Limited access to Chagas disease diagnosis and treatment is a major obstacle to reaching the 2020 World Health Organization milestones of delivering care to all infected and ill patients. Colombia has been identified as a health system in transition, reporting one of the highest levels of health insurance coverage in Latin America. We explore if and how this high level of coverage extends to those with Chagas disease, a traditionally marginalised population. Using a mixed methods approach, we calculate coverage for screening, diagnosis and treatment of Chagas. We then identify supply-side constraints both quantitatively and qualitatively. A review of official registries of tests and treatments for Chagas disease delivered between 2008 and 2014 is compared to estimates of infected people. Using the Flagship Framework, we explore barriers limiting access to care. Screening coverage is estimated at 1.2% of the population at risk. Aetiological treatment with either benznidazol or nifurtimox covered 0.3-0.4% of the infected population. Barriers to accessing screening, diagnosis and treatment are identified for each of the Flagship Framework's five dimensions of interest: financing, payment, regulation, organization and persuasion. The main challenges identified were: a lack of clarity in terms of financial responsibilities in a segmented health system, claims of limited resources for undertaking activities particularly in primary care, non-inclusion of confirmatory test(s) in the basic package of diagnosis and care, poor logistics in the distribution and supply chain of medicines, and lack of awareness of medical personnel. Very low screening coverage emerges as a key obstacle hindering access to care for Chagas disease. Findings suggest serious shortcomings in this health system for Chagas disease, despite the success of universal health insurance scale-up in Colombia. Whether these shortcomings exist in relation to other neglected tropical diseases needs investigating. We identify opportunities for improvement that can inform additional planned health reforms.
Introducción. Las infecciones respiratorias agudas (IRA) son un importante problema de salud pública a nivel mundial.Objetivo. Explorar las desigualdades de la tasa de mortalidad debida a IRA (TM-IRA) en <5 años, de acuerdo a variables socioeconómicas.Materiales y métodos. Se realizó un análisis ecológico para estudiar las desigualdades a nivel municipal de las TM-IRA en <5 años. Los datos se obtuvieron a partir de registros de muertes del Departamento Administrativo Nacional de Estadística. En análisis de desigualdades en <5 incluyó: 1) Clasificación de la población por estatus socioeconómico y 2) Medición del grado de desigualdad. Como resultado en salud se utilizó la TM-IRA en <5 años. Se estimaron tasas a nivel nacional y municipal para 2000, 2005, 2010, 2013. Se calcularon razones y diferencias de tasas y curvas de concentración para observar las desigualdades.Resultados. Entre 2000-2013 murieron en Colombia por IRA 18.012 <5 años. La TM-ARI fue mayor en niños que en niñas. En el periodo, se observó un incremento en la brecha de mortalidad infantil en ambos sexos. En 2013, la tasa en niños que murieron en municipios con mayor pobreza fue 1,6 veces mayor que la de niños en aquellos con menor. En niñas, para 2015 y 2013, la tasa en el tercil más pobre fue 1,5 y 2 veces mayor que la del primer tercil, respectivamente.Conclusión. Las desigualdades en la TM-IRA entre los municipios más pobres en comparación con los más ricos continúan siendo un reto importante en salud pública.
Objectives: Acute respiratory infections (ARI) are a great leading morbidity and mortality cause worldwide. The aim of this study was to describe ARI mortality inequalities in children under five years in Colombian municipalities. MethOds: Vital statistics from National Administrative Department of Statistics (DANE, in Spanish) were used to estimate ARI mortality rates per 100.000 children under five years (ARIMR< 5) in the Colombian municipalities with mortality registers during 2000, 2005, 2010 and 2013. ARIMR< 5 were compared between groups determined by unsatisfied basics needs (UBN) quintiles as a proxy of poverty (Q1, Q2, Q3, Q4 and Q5, being the last the poorest). Concentration curves were also used to show socioeconomic inequalities in ARIMR< 5. Results: Between 2000 and 2013 Colombia registered 18,012 deaths in children under five years old caused by ARI, 55.7% of cases were boys. The ARIMR< 5 for Colombian boys in 2000 and 2013 was 49.9 and 19.6 per 100.000, respectively. For girls, the rates were 45.2 and 17 per 100.000. At municipal level, ARI mortality rates in boys were higher in poorest municipal quintiles (Q4 and Q5) than Q1 (lowest poverty) for 2005, 2010 and 2013. ARI mortality rates in girls showed the same pattern than in boys. In 2000, an inverse relationship between poverty and ARI mortality in both, girls and boys. In boys, ARIMR< 5 was 1.6, 2.2 and 2.3 times greater in quintiles with high poverty (Q4 and Q5) versus Q1 (low poverty) for, 2005, 2010 and 2013, respectively. In girls, the differences were 1.7, 2.1 and 2.8. Concentration curves showed that 52% of the total IRA boys deaths were accumulated in the 15% of poorest population. In girls, the same proportion was accumulated in 22% of poorest population. cOnclusiOns: The current inequalities of the IRA mortality in Colombian municipalities continue to be a huge challenge for Colombian stakeholders.
Our results are an important input for the planning of services and cost-effectiveness studies for screening tests for Chagas' disease in Colombian blood banks.
Trabajos aceptados: modalidad póster Resultados: En los R1 y R2 se observaron avances en todos los indicadores de competencia clínica y en la calificación global, lo cual se expresó con diferencias estadísticamente significativas; los R1, en la calificación global (medición inicial vs. final) mostraron las medianas: 44-110 (p= 0.018); los R2, la calificación global mostró: 52.5-128 (p= 0.027). Discusión: A partir de los resultados, se observaron algunos de los planteamientos teóricos de la perspectiva participativa de la educación. Conclusión: Una intervención educativa participativa implementada por un médico residente de urología de cuarto año, produce avance de la competencia clínica de R1 y R2 de la misma especialidad.
Exclusion of productivity costs of mortality had minimal impact with similar ICERs to FC method. CONCLUSIONS: The differences in ICERs of IIV4 vs IIV3 with HC method, FC method or no productivity costs of mortality were significantly narrower than those of HD vs IIV3. Relative vaccine efficacy against influenza-related deaths to IIV3 was a key driver of productivity costs; therefore, choice of methods could be crucial with massively different results. Those conclusions were robust to alternative friction periods and elastic factors.
PIN39BurdeN of dIsease aNd ecoNomIc ImPact of malarIa IN colomBIa, 2012
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