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      Efectividad del gasto en salud pública y su impacto sobre la mortalidad por infección respiratoria aguda - Colombia (2017) Translated title: Eficácia das despesas com a saúde pública e seu impacto na mortalidade de infecção respiratória aguda - Colômbia (2017). Translated title: Effectiveness of public health expenditure and its impact on acute respiratory infection mortality - Colombia (2017)

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          Abstract

          Resumen Los programas de inmunización representan una de las principales actividades de Salud Pública (SP). OBJETIVO Evaluar la efectividad del gasto en SP en función de la Mortalidad por Infección Respiratoria Aguda (IRA) y de la Cobertura de Programas de inmunización con Pentavalente, tercera dosis (menores de un año) en Colombia durante el año 2017. MATERIALES Y MÉTODOS Estudio ecológico - transversal, de tipo analítico acerca del comportamiento de las variables en mención. RESULTADOS No se evidencian correlaciones significativas entre el gasto ejecutado, y la mortalidad asociada a IRA, tampoco para con las coberturas en programas de inmunización. CONCLUSIÓN Existen factores de confusión asociados a las variables de interés.

          Translated abstract

          Abstract Immunization is one of the different activities developed by Public Health (PH). OBJECTIVE To evaluate the effectiveness of PH expenditure based on Mortality from Acute Respiratory Infection (ARI) and Vaccination Coverage with Pentavalent, third dose (children less than one year old) in Colombia during 2017. MATERIALS AND METHODS: Study ecological - cross-sectional, analytical type about the course of the mentioned variables. RESULTS There are no significant correlations between the expenditure executed, and the mortality associated with ARF, neither for the vaccination coverage. CONCLUSION There are confounding factors associated with the variables of interest.

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          Most cited references23

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          La Agenda 2030 y los Objetivos de Desarrollo Sostenible, Una oportunidad para América Latina y el Caribe

          (2018)
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            Infant mortality due to acute respiratory infections: the influence of primary care processes.

            A population-based case control study was conducted to ascertain whether the process of primary care can be a determinant of infant mortality due to Acute Respiratory Infection (ARI). Cases were 118 infants who died from ARI, individually matched with 118 infants who suffered an ARI episode and recovered. Information was gathered through interviewing mothers. Study variables were assembled into five subsets: children's characteristics; mothers' characteristics; access to medical services; process of primary care, and; sociodemographic variables. An index per subset was built to analyze the independent influence of each on ARI death risk. The index was constructed upon the weighted sum of the adjusted odds ratios (OR) within each subset. Then, the values of each index were collapsed into high/low values with the 50 percentile as a cut-off value. Next, by means of a conditional logistic regression procedure, an explanatory model of ARI mortality was obtained. The final multivariate model included the indexes that showed an independent effect: I) Process of care (OR 9.68, CI 95% 3.59-26.1): inadequate referral, attention provided by more than one physician and being attended by a private physician; II) children's characteristics (OR 7.22, CI 95% 2.35-22.2): perinatal history, lack of breast-feeding and incomplete immunization scheme; III) access to medical services (OR 5.27, CI 95% 2.02-13.7): geographic and economic barriers, lack of confidence in public health services, and; IV) mothers' characteristics (OR 4.03, CI 95% 1.18-13.8), mainly represented by untimely care seeking. We conclude that the management of the disease is a key determinant in which factors relating to the mother and the health services are strongly related. Our study reveals untimely care seeking, difficult access and inadequate disease treatment as important factors which deserve careful attention in the future. We also confirm the importance of biological determinants previously described. A main strategy to reduce infant mortality due to ARI should be to encourage training of primary care physicians, including private practitioners, focused on providing effective case management and emphasizing the education to mothers.
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              An evaluation of the emerging interventions against Respiratory Syncytial Virus (RSV)-associated acute lower respiratory infections in children

              Background Respiratory Syncytial Virus (RSV) is the leading cause of acute lower respiratory infections (ALRI) in children. It is estimated to cause approximately 33.8 million new episodes of ALRI in children annually, 96% of these occurring in developing countries. It is also estimated to result in about 53,000 to 199,000 deaths annually in young children. Currently there are several vaccine and immunoprophylaxis candidates against RSV in the developmental phase targeting active and passive immunization. Methods We used a modified CHNRI methodology for setting priorities in health research investments. This was done in two stages. In Stage I, we systematically reviewed the literature related to emerging vaccines against RSV relevant to 12 criteria of interest. In Stage II, we conducted an expert opinion exercise by inviting 20 experts (leading basic scientists, international public health researchers, international policy makers and representatives of pharmaceutical companies). The policy makers and industry representatives accepted our invitation on the condition of anonymity, due to the sensitive nature of their involvement in such exercises. They answered questions from the CHNRI framework and their “collective optimism” towards each criterion was documented on a scale from 0 to 100%. Results In the case of candidate vaccines for active immunization of infants against RSV, the experts expressed very low levels of optimism for low product cost, affordability and low cost of development; moderate levels of optimism regarding the criteria of answerability, likelihood of efficacy, deliverability, sustainability and acceptance to end users for the interventions; and high levels of optimism regarding impact on equity and acceptance to health workers. While considering the candidate vaccines targeting pregnant women, the panel expressed low levels of optimism for low product cost, affordability, answerability and low development cost; moderate levels of optimism for likelihood of efficacy, deliverability, sustainability and impact on equity; high levels of optimism regarding acceptance to end users and health workers. The group also evaluated immunoprophylaxis against RSV using monoclonal antibodies and expressed no optimism towards low product cost; very low levels of optimism regarding deliverability, affordability, sustainability, low implementation cost and impact on equity; moderate levels of optimism against the criteria of answerability, likelihood of efficacy, acceptance to end-users and health workers; and high levels of optimism regarding low development cost. They felt that either of these vaccines would have a high impact on reducing burden of childhood ALRI due to RSV and reduce the overall childhood ALRI burden by a maximum of about 10%. Conclusion Although monoclonal antibodies have proven to be effective in providing protection to high-risk infants, their introduction in resource poor settings might be limited by high cost associated with them. Candidate vaccines for active immunization of infants against RSV hold greatest promise. Introduction of a low cost vaccine against RSV would reduce the inequitable distribution of burden due to childhood ALRI and will most likely have a high impact on morbidity and mortality due to severe ALRI.
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                Author and article information

                Journal
                ene
                Ene
                Ene.
                Martín Rodríguez Álvaro (Santa Cruz de La Palma, La Palma, Spain )
                1988-348X
                2020
                : 14
                : 3
                : e14309
                Affiliations
                [1] Bogotá orgnameFundación Universitaria Juan N. Corpas Colombia
                Article
                S1988-348X2020000300009 S1988-348X(20)01400300009
                3df79ce6-bb5f-41eb-998a-bb9f1664fa92

                This work is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License.

                History
                : 01 June 2020
                : 01 May 2020
                Page count
                Figures: 0, Tables: 0, Equations: 0, References: 23, Pages: 0
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                SciELO Spain

                Categories
                Artículos

                Costo y análisis de costos,Immunization Programs,Preventive Medicine,Public Health,Programas de Inmunización,Medicina Preventiva,Salud Pública,Cost and cost analysis

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