Elsevier

Public Health

Volume 138, September 2016, Pages 74-85
Public Health

Original Research
Exploratory analysis of preventable first day mortality in Colombia

https://doi.org/10.1016/j.puhe.2016.03.017Get rights and content

Highlights

  • In Colombia, 17.87% of the infant mortality rate is first day mortality (FDM).

  • Twenty-six percent of FDM is of babies with normal gestation age and birthweight.

  • The percentage of FDM which is defined preventable is 37.10.

  • Preventable FDM is mainly correlated with inferior access to care.

  • Most preventable FDM can be eliminated by optimal care.

Abstract

Objective

The goal of this study was to inform public health policy which can reduce Colombia's estimated infant mortality rate (IMR), 17.78 deaths for 1000 live births (2011), by lowering preventable first day mortality (PFDM).

Study design

This study combined a time series analysis, using a linear regression method, for the period 2001–2012 with a cross-sectional analysis, using odds ratios and bi-variate methods, for the year 2012 to study first day mortality (FDM) and PFDM classified by biological, socio-economic, and medical correlates.

Methods

The study examined the trends for 2001–2012 in Colombia's infant mortality rate per 1000, and in the relative significance of PFDM by cause. It established the relative odds of PFDM for 2012 by major risk categories, defined by birthweight and gestational age, and within those by biological, sociodemographic risk factors or groups and by potential access to and use of care. Then, the study established the major causes of PFDM within major risk categories and groups.

Results

Between 2001 and 2012, the average annual rate of FDM declined by 6.30%, while overall infant mortality only declined by 4.20%. Yet, in 2012, 37.04% of FDM was preventable by using proper pregnancy control (7.00% of total preventable), proper care during childbirth (37.20%), and handling causes associated with late diagnosis and treatment (55.80%). PFDM is primarily a socio-economic phenomenon, even among normal weight and gestational age newborns, who account for 32.73% of PFDM due to improper management of pregnancy and delivery among lower socio-economic and outlying populations, specifically in rural areas and among members of the inferior subsidised social insurance regime.

Conclusion

From efficacy and probable cost effectiveness perspectives, intervention priority should be given to handling babies with normal gestation age and birthweight, and then to babies with very low gestation age and birthweight. At the same time, more prenatal visits could lead to fewer very high-risk situations at the outset. In view of the Colombian regulation to the contrary, the use of foetal monitoring and echography methods by all general practitioners should be considered. They should be trained accordingly. Policies should focus on members of the underprovided subsidised health insurance regime, rural areas, young, low-educated and single mothers during pregnancy, mainly delivery.

Introduction

The infant mortality rate (IMR) in Latin America for 2010–2011 was estimated to be 15.70 deaths per 1000 live births (LBs). This rate varies across the subcontinent, ranging from 4.20 deaths per 1000 LB in Cuba to 59.0 deaths per 1000 LBs in Bolivia in 2012. This average is nearly three times that of the Canadian and US rates of 5.90 deaths per 1000 LBs for 2011–2013.1, 2 Colombia, with a population of about 47 million (2012) over an area of 1,141,748 km2, had an estimated IMR of 17.78 deaths per 1000 LBs (2011). This average, which represents wide regional disparities within the country, makes Colombia's IMR fairly representative of Latin America.3, 4

UNICEF et al. reported that ‘about two-thirds of infant deaths occur in the first month or life; of those who die in the first month, about two-thirds die in the first week of life; of those who die in the first week, two-thirds die in the first 24 h of life’.5, 6 Colombia generally conforms to the UNICEF pattern with regard to the neonatal mortality rate (NMR) and early neonatal mortality rate, and is doing somewhat better with the first day mortality (FDM) share, which is 42.22% of the first week rate. However, the FDM in particular may be subject to a downward bias because some infant deaths, primarily close to the birth, may go unreported.7

General interrelated risk factors of FDM such as birthweight (BW), gestation age, baby boys, and mother's age, are known.8, 9 Yet, data and analyses about the relative contribution of these risk factors to FDM and its specific causes and, in this context, about the role of sociodemographic factors and medical care, are limited. Therefore, the purpose of this study was to address this information gap and thereby help guide public health policy regarding FDM at least in Colombia, by focussing on presumed cost effective interventions to prevent FDM. To this end, the paper had the following analytic objectives. First, to study the trends of infant and first day infant mortality (FDM) in Colombia for the period 2001–2012, to establish the relative significance of FDM over time. Second, to classify FDM by preventable, semi-preventable, and non-preventable causes, to identify potentially cost effective interventions. Third, to study the biological, socio-economic and medical correlates of preventable FDM (PFDM) and of its causes, to identify targets for cost-effective intervention.

Section snippets

Methods

This study combined (a) a time series analysis, using a linear regression, to study the evolution of FDM in Colombia from 2001 to 2012 with (b) a cross-sectional analysis using linear regressions and bi-variate techniques, to study the biological, socio-economic, and health care correlates of FDM and PFDM in Colombia for the year 2012.

Results

The Colombian registered IMR declined from 19.92 in 2001 to 12.14 deaths per 1000 LBs in 2012, falling by an average of 4.2% annually (Fig. 1). The FDM rate decreased from 4.71 to 2.17 deaths per 1000 LB during the same period, falling by an average of 6.3% annually. Hence, the FDM rate declined more quickly than the overall IMR and, as a result, the proportion of infant deaths that occurred in the first 24 h of life decreased from 23.60% in 2001 to 21.20% in 2012.

The decline rate of FDM was

Discussion

The infant mortality rate in Colombia declined during the period from 2001 to 2012. This decline was led by FDM, which has had little research. In 2012, the avoidable deaths on the first day of life were 17.87% of infant mortality and 42.18% of early neonatal deaths (occurring in the first week of life). Still, Colombia is in the upper range between 25% and 45% of early neonatal mortality established by the World Health Organization (WHO), especially if we consider under-reporting of both

Acknowledgements

The authors are indebted to DANE, ICESI University, PROESA, and the World Bank for general support. In addition, we wish to thank Juan David Martin, Katherine Guerrero, and Maria Fernanda Bonilla, research assistants, for their contribution and processing of statistical information.

Ethical approval

The data used in this paper were not collected from human subjects, so it did not require ethical approval. The availability of data was based on an agreement between DANE and ICESI University, and it did not include

Competing interests

Only the authors are responsible for the views expressed in this paper. There are no conflicts of interest.

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