Original ResearchExploratory analysis of preventable first day mortality in Colombia
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.
References (30)
- et al.
A practical classification of newborn infants by weight and gestational age
J Pediatr [Internet]
(1967) - et al.
Pediatric intensive care in Latin America
Med Intensiva Engl enero
(2012) Health situation in the Americas: basic health indicators 2014. [Internet]
(2014)- et al.
Regional strategy and plan of action for neonatal health within the continuum of maternal, newborn, and child care – matneonat-regional_strategy_plan_action_neonatal_health_2008.pdf [Internet]
(2008) Indicadores básicos 2010: Situación de salud de Colombia [Internet]
(2011)- et al.
Brechas regionales de la mortalidad infantil en Colombia
Rev Peru Med Exp Salud Pública [Internet]
(2013) Neonatal and perinatal mortality: country, regional and global estimates. [Internet]
(2006)Estado Mundial de la Infancia 2009: Salud materna y neonatal [Internet]
(2008)- et al.
Resolving the enigma of infant mortality rate in Colombia [Internet]
(2012) - et al.
Edad materna como factor de riesgo de prematuridad en España: área mediterránea
Nutr Hosp [Internet]
(2013)
On the concept of health capital and the demand for health
J Polit Econ [Internet]
Registro especial de prestadores de servicios de salud (REPS) [Internet]
Ley 100 de 1993. Por medio de la cual se crea el Sistema General de Seguridad Social Integral. Libro II. Sistema General de Seguridad Social en Salud. Ley 100
La Sinfonía Inconclusa: la Reforma del Sistema de Salud de Colombia. [Internet]
Colombia case study: the subsidized regime of Colombia's national health insurance system [Internet]
Cited by (2)
Análisis de Costo Efectividad del Contacto Piel a Piel al Nacimiento, Temprano vs Inmediato, en la Morbilidad Neonatal de Recién Nacidos de Bajo Riesgo
2022, Value in Health Regional IssuesCitation Excerpt :Por tanto, la frecuencia de las enfermedades de este grupo de neonatos y el uso de recursos para su atención tienen el potencial de generar un impacto importante en los recursos del sistema de salud. Por otro lado, existen intervenciones preventivas en la atención binomio madre-hijo, que tienen el potencial de disminuir esta morbilidad, especialmente cuando se logran coberturas mayores al 80% en la población, y por tanto se convierten en prioridad su implementación en la atención del binomio.8,9 Además, el lograr una cobertura alta en la atención en salud podría conducir a una reducción de costós por la atención de estas enfermedadess.
Comparison of the Effects of Different Skin-to-Skin Contact Onset Times on Breastfeeding Behavior
2021, Breastfeeding Medicine