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ObjectiveMaternal mortality reduction is a Millennium Development Goal. In Colombia, there is a large disparity in the maternal mortality ratio (MMR) between and into departments (states) and also between municipalities. We examined socioeconomics variables at the municipal and departmental levels which could be associated to the municipal maternal mortality in Colombia.MethodsA multilevel ecology study was carried out using different national data sources in Colombia. The outcome variable was the MMR at municipal level in 2011 with multidimensional poverty at municipal and department level as the principal independent variables and other measures of the social and economic characteristics at municipal and departmental level were also considered explicative variables (overall fertility municipal rate, percentage of local rural population, health insurance coverage, per capita territorial participation allocated to the health sector, transparency index and Gini coefficient). The association between MMR and socioeconomic contextual conditions at municipal and departmental level was assessed using a multilevel Poisson regression model.ResultsThe MMR in the Colombian municipalities was associated significantly with the multidimensional poverty (relative ratio of MMR: 3.52; CI 95%: 1.09-11.38). This association was stronger in municipalities from departments with the highest poverty (relative ratio of MMR: 7.14; CI 95%: 2.01-25.35). Additionally, the MMR at municipal level was marginally associated with municipally health insurance coverage (relative ratio of MMR: 0.99; CI 95%: 0.98-1.00), and significantly with transparency index at departmental level (relative ratio of MMR: 0.98; CI 95%: 0.97-0.99).ConclusionPoverty and transparency in a contextual level were associated with the increase of the municipal MMR in Colombia. The results of this study are useful evidence for informing the public policies discussion and formulation processes with a differential approach.

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Strain monitoring for emergence of novel strains after the introduction of rotavirus vaccine is an integral component of routine rotavirus immunization programs. Using a laboratory based strain surveillance system between 2008 and 2012, a wide variation in strain pattern in Colombia was founded both before and after the introduction of a monovalent rotavirus vaccine in 2009. G2P[4], a strain fully heterotypic to the vaccine was predominant before vaccine introduction in 2008 (47%) and after vaccine introduction in 2010 (54%), 2011 (86%), and 2012 (32%). The presence of this strain before the introduction of vaccine and decreasing prevalence during the most recent surveillance year suggests secular variation rather than vaccine pressure as a cause for this fluctuation. While strain monitoring can be valuable after vaccine introduction, these surveillance data alone without information on disease incidence or strain specific vaccine effectiveness can be prone to misinterpretation with regard to the role of vaccine pressure on emergence of new or persistent strains.

Introducción. Las desigualdades en salud se generan por diferencias en las condiciones sociales y económicas, lo cual influye en el riesgo de enfermar y la forma de enfrentar la enfermedad.Objetivo. Evaluar las desigualdades sociales en salud en Colombia, utilizando el tipo de afiliación al sistema de salud como un parámetro representativo (proxy) de la condición socioeconómica.Materiales y métodos. Se trata de un análisis descriptivo y retrospectivo en el que se calcularon las tasas específicas de incidencia, ajustadas por edad y sexo, para eventos de notificación obligatoria, utilizando el régimen de afiliación (subsidiado o contributivo) como variable representativa del nivel socioeconómico. Las estimaciones se hicieron a nivel departamental para el 2015. Las desigualdades sociales se calcularon en términos de brechas absolutas y relativas.Resultados. Se evidencian desigualdades sociales en la ocurrencia de eventos de notificación obligatoria, las cuales desfavorecen a la población afiliada al régimen subsidiado. En esta población, se reportaron 82,31 casos más de malaria Plasmodium falciparum por 100.000 afiliados, que los notificados en el régimen contributivo. Respecto a la brecha relativa, el pertenecer al régimen subsidiado se asocia con un aumento de 31,74 veces del riesgo de morir por desnutrición en menores de cinco años. Otros eventos también presentaron profundas desigualdades, como los relacionados con la salud sexual y reproductiva (mortalidad materna, sífilis gestacional y sífilis congénita), las enfermedades infecciosas y las enfermedades transmisibles relacionadas con la pobreza (lepra y tuberculosis).Conclusión. El tipo de afiliación al Sistema General de Seguridad Social en Salud en Colombia es un buen indicador del nivel socioeconómico, y es un factor predictor de mayor morbilidad y mortalidad prematura asociada con los factores determinantes sociales de la salud.

Introducción. El homicidio es un indicador universal de violencia social con grandes consecuencias en salud pública. Objetivo. Describir la mortalidad por homicidios, y analizar su tendencia y su distribución geográfica en Colombia entre 1998 y 2012. Materiales y métodos. Se hizo un estudio descriptivo basado en la información de las bases de datos sobre mortalidad y las proyecciones de población del Departamento Administrativo Nacional de Estadística, DANE. Se calcularon las tasas de mortalidad específica y ajustada por edad y sexo. Se analizó la distribución geográfica del promedio de tasas ajustadas a nivel municipal. Resultados. En Colombia se registraron 331.470 homicidios entre 1998 y 2012. La tasa cruda promedio fue de 51,5 por 100.000 habitantes: 95,9 en hombres y 8,2 en mujeres. A partir del 2003 se observó una disminución en el número de muertes y tasas de mortalidad. El 91,9 % de las víctimas fueron hombres. Las tasas de mortalidad más altas se observaron en el grupo de 20 a 29 años. El mecanismo más frecuentemente involucrado fue el arma de fuego: en ocho de cada diez homicidios en hombres y en siete de cada diez en mujeres. De los 1.122 municipios, 186 estaban en el quintil más alto y acumularon el 50,1 % de las defunciones. Conclusión. En Colombia los homicidios han sido una de las principales causas de muerte, con una distribución geográfica heterogénea y una tendencia hacia la reducción después de 2002. El análisis y la comprensión de este problema de salud pública exigen el uso de metodologías analíticas multidisciplinarias. Materials and methods:We conducted a descriptive study of deaths by homicide in Colombia between 1998 and 2012 using official mortality databases and the population projections of the Departamento Administrativo Nacional de Estadística, DANE. We calculated age-and sex-specific mortality rates, and we analyzed the geographical distribution of mean-adjusted homicide mortality rates at municipal level. Results: Between 1998 and 2012, 331,470 homicides were reported in Colombia. The mean crude rate was 51.5 per 100,000 inhabitants: 95.9 in men and 8.2 in women. Since 2003, a decrease in the number of deaths and rates was observed; 91.9% of the victims were men and the highest mortality rates were reported in the 20-29 years old group. The most frequently involved mechanism was the firearm: Eight of 10 homicides in men, and seven of 10 homicides in women. Out of 1,122 municipalities, 186 were in the highest quintile, accumulating 50.1% of all deaths. Conclusions: In Colombia, homicides have been one of the leading causes of death with a trend towards reduction since 2002. Its geographical distribution has been heterogeneous. To continue addressing this public health issue we must recur to multidisciplinary analytical methodologies for a better understanding of the phenomenon.

This study sought to understand the components of the relationship between mothers from Nasa and Misak ethnicities from Cauca, Colombia, and both the indigenous and Western health care services for maternal health, through qualitative approach harmonizing the model of construction of meaning and grounded theory. Elements about health, illness and motherhood conceptualization inside each system were rescued. These elements are expressed in care practices, being the labor the moment of greatest tension. Patterns of relationships between actors of both medical systems were also identified. An indigenous health system with low development and progressive loss of values, in conjunction with a Western medical system without culturally appropriate health services, results in mothers in an environment of uncertainty where it is not possible to carry out traditional practices, nor having access to proper allopathic services.