BackgroundAfter 8 months of the COVID-19 pandemic, Latin American countries have some of the highest rates in COVID-19 mortality. Despite being one of the most unequal regions of the world, there is a scarce report of the effect of socioeconomic conditions on COVID-19 mortality in their countries. We aimed to identify the effect of some socioeconomic inequality-related factors on COVID-19 mortality in Colombia.MethodsWe conducted a survival analysis in a nation-wide retrospective cohort study of confirmed cases of COVID-19 in Colombia from 2 March 2020 to 26 October 2020. We calculated the time to death or recovery for each confirmed case in the cohort. We used an extended multivariable time-dependent Cox regression model to estimate the HR by age groups, sex, ethnicity, type of health insurance, area of residence and socioeconomic strata.ResultsThere were 1 033 218 confirmed cases and 30 565 deaths for COVID-19 in Colombia between 2 March and 26 October. The risk of dying for COVID-19 among confirmed cases was higher in males (HR 1.68 95% CI 1.64 to 1.72), in people older than 60 years (HR 296.58 95% CI 199.22 to 441.51), in indigenous people (HR 1.20 95% CI 1.08 to 1.33), in people with subsidised health insurance regime (HR 1.89 95% CI 1.83 to 1.96) and in people living in the very low socioeconomic strata (HR 1.44 95% CI 1.24 to 1.68).ConclusionOur study provides evidence of socioeconomic inequalities in COVID-19 mortality in terms of age groups, sex, ethnicity, type of health insurance regimen and socioeconomic status.
Introducción: En el fenómeno migratorio desde Venezuela hacia Colombia, las mujeres representan una proporción significativa entre los migrantes irregulares; de ellas, las gestantes han sido priorizadas por sus condiciones particulares de vulnerabilidad. Sin embargo, se desconocen sus condiciones de salud. Objetivos: Caracterizar multidimensionalmente la situación de salud de las gestantes venezolanas migrantes irregulares, residentes en las principales ciudades receptoras del Caribe colombiano: Barranquilla y Riohacha. Metodología: Estudio descriptivo de corte transversal en 520 gestantes venezolanas migrantes irregulares, captadas por muestreo sistemático en hospitales públicos, y comunitariamente a través de búsqueda activa en bola de nieve entre agosto de 2018 y mayo de 2019. Con un cuestionario estandarizado se evaluaron los principales problemas de salud, estado nutricional, seguridad alimentaria, presencia de síntomas depresivos, accesibilidad y satisfacción con los servicios de salud. Resultados: La mitad percibía su salud durante el embarazo como buena o muy buena (53,4%). El 51,3% presentó anemia ferropénica y la mayoría algún grado de inseguridad alimentaria (87,5%). La prevalencia de síntomas depresivos clínicamente significativos fue del 32,1%. Una alta proporción reportó algún tipo de violencia por parte de su pareja (90,2%). El 25,9% requirió atención sanitaria por urgencias independiente de la atención prenatal. El 62,7% calificó la atención por urgencias como muy buena o buena, mientras que el 73,1% piensa que le brindaron la atención necesaria para su problema de salud. Conclusiones: Los principales problemas de salud en gestantes que participaron en el estudio corresponden a la inseguridad alimentaria, anemia, síntomas depresivos, violencia de pareja y ausencia de controles prenatales. Su situación de salud debe considerarse en el marco del proceso migratorio y desde los determinantes sociales de la salida, tránsito, llegada y retorno. Las medidas de atención primaria para esta población deben seguir siendo fortalecidas por el sistema de salud a nivel territorial y basadas en evidencia.
Objectives Conducting contact tracing programs in low and middle-income countries is challenging and there is no evidence of their effectiveness in Latin America. We evaluated the effectiveness of contact tracing on reducing fatality from COVID-19 in Colombia. Study design Retrospective cohort study with nation-wide data of suspected and confirmed cases of SARS-CoV-2 infection and their registered contacts. Methods We analyzed confirmed and suspected COVID-19 cases and their chains of contact using a nation-wide registry from March 28, 2020 to January 13, 2021. To estimate the effect of contact tracing on fatality we adjusted a multilevel negative binomial model using as outcome variable the number of deaths and off-set variable the number of people within a chain of contacts. Sensitivity analysis was conducted using different cut-off values of contacts traced and a logistic model for the effect of contact tracing on death at individual level. Results We analyzed 1,4 million cases, 542 936 chains of contact, and 46 087 deaths. Only 5,8% of total cases and contacts were included in a chain of a case and five or more contacts. We found that tracing of at least five contacts per case reduce fatality by 48% (95% CI: 45-51) and, at the current levels of tracing in Colombia, it prevents 1.8% of deaths. Results obtained from the sensitivity analysis were consistent with the reduction of fatality at individual level and higher protective effect with higher number of contacts traced. Conclusions In Colombia, tracing of at least five contacts per case reduces fatality from COVID-19. The coverage and intensity of tracing needs to be increased as a strategy to mitigate fatality in Colombia.
Objetivo Describir los modos de vida y el estado de salud de salud de migrantes venezolanos y colombianos de retorno asentados en Villa Caracas, Barranquilla, en el año 2018.Método Estudio descriptivo de corte transversal con muestreo sistemático de viviendas. Fueron incluidas 229 personas mayores de 15 años procedentes de 90 viviendas.Resultados Se encontraron diferencias en las rutas para llegar, tiempos de traslado y estancia en el asentamiento entre migrantes venezolanos y colombianos en retorno. Las condiciones de la vivienda y el acceso a los servicios públicos son limitadas, menos de la mitad de las viviendas tienen acceso a acueducto, alcantarillado y baño. En general el estado de salud auto-reportado por los migrantes es muy bueno o bueno, las prevalencias de enfermedades crónicas fueron relativamente bajas, con excepción de hipertensión arterial. De los que consultaron al servicio de urgencias, la mayoría reportó acceso efectivo. Se encontraron síntomas depresivos clínicamente significativos para el 20% de la población encuestada.Conclusiones Los migrantes de Villa Caracas se encuentran en condiciones de alta vulnerabilidad social dadas sus condiciones económicas y ambientales. A pesar de la falta de aseguramiento al sistema de salud colombiano, reportaron acceso a la atención por urgencias.
OBJECTIVES To explore the experiences of irregular (undocumented) Venezuelan migrants in accessing prenatal health services in Colombia and to examine the economic, social, and cultural resources mobilized by them to gain access to care. METHODS Data was retrieved from the qualitative component of a multi-method research conducted with pregnant immigrants in Barranquilla, Colombia, between 2018 and 2019, and triangulated with a review of regulations established by the Ministry of Health and Social Protection. RESULTS Having limited economic capital, participants use social capital from personal networks and migrant organizations. They obtain cultural health capital in the form of information on the health system and use their cultural competencies to interact with this system. CONCLUSIONS Migrants exert their agency through the use of capitals, although with certain constraints. Policies aimed at this social group should consider the strengths of migrants.
Objective. To provide an overview of morbidity and mortality due to acute diarrheal disease in Mexico in order to understand its magnitude, distribution, and evolution from 2000 to 2016. Materials and methods. We carried out a longitudinal ecological study with secondary sources of information. We used data from epidemiological surveillance, health services, and vital statistics. We calculated and mapped measures of utilization of health services rates and mortality due to diarrheal diseases. Results. Diarrhea morbidity decreased by 42.1% across the period. However, emergency department attendances increased by 50.7% in the Ministry of Health. The hospitalization rate and mortality among the general population decreased by 37.6 and 39.7%, respectively, and the infant mortality rate decreased by 72.3% among children under five years of age. Chiapas and Oaxaca had the highest mortality among the states of Mexico. Conclusions. Cases of diarrhea, including rotavirus, have decreased in Mexico. However, in 2016, 3.4 per 100 000 people died due to diarrhea, which could have been avoided with health promotion.
En junio de 2021, un grupo de distinguidos académicos colombianos sometieron a su revista algunas reflexiones1 sobre el Índice de Resiliencia Epidemiológica Municipal (IREM), el cual fue propuesto por el Ministerio de Salud y Protección Social de Colombia como una herramienta para la toma de decisiones en los territorios del país respecto a la reactivación económica que se plantea en el proceso de superación de la crisis social y económica relacionada con la pandemia por COVID-19. A continuación, deseamos aportar algunos elementos analíticos e interpretativos sobre dichas reflexiones con el ánimo de enriquecer la discusión.
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