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Revista chilena de pediatría

versión impresa ISSN 0370-4106

Rev. chil. pediatr. vol.88 no.4 Santiago  2017

http://dx.doi.org/10.4067/S0370-41062017000400004 

ORIGINAL ARTICLE

 

Death from external causes in infants in Colombia 2005-2013

Muertes de causa externa en menores de cinco años en Colombia 2005-2013

 

Diego Rossellia, Juan C. Carlierb, Mariana Arango Lozanob, Luis Hernando Murciab, Andrés Felipe Amayab, Raúl del Río-McMahonb

aProfessor, Clinical Epidemiology and Biostatistics Department, Pontificia Universidad Javeriana, Medical School, Bogota, Colombia
bMedical students, Pontificia Universidad Javeriana, Medical School, Bogota, Colombia

Correspondencia a:


Latin America has shown a significant reduction in infant mortality in recent years. The objective of this study was to analyze official data for children under five years of age in Colombia, emphasizing external causes of death, which have been less studied. Patients and Method: Descriptive cross-sectional design using secondary information from death records reported by the National Administrative Department of Statistics (DANE) and information dynamic tables of vital statistics, taken from the official information system of the Ministry of Health and Social Protection (SISPRO), between 2005 and 2013 were reviewed. The information was organized in tables for descriptive analysis of variables such as age, sex, and specific cause of death, by departments. Results: In this period 106,339 children under 5 years died; 85,897 of them (81%) in the first year of life. The number of deaths decreased from 14.266 in 2005, to 9.499 in 2013. The main external cause of death was drowning, responsible for 1749 deaths, followed by traffic accidents, 1.282. Homicides were responsible for 692 deaths. In all the causes of death analyzed there was a decline over the decade. Discussion: Colombia is accomplishing the fourth millennium goal, “reduce the mortality of children under 5 years.” Progress has been made in deaths from external causes, but there is still some way to go.

Keywords: Cause of Death; Colombia; Infant Mortality; Millennium Development Goals; Vital Statistics


 

Introduction

Reducing child mortality is part of the Millennium Development Goals, set in 20001, and is one of the most difficult aspects to accomplish in the public health system in Colombia. According to official statistics, mortality rate in children younger than 5 years old has been reduced from 24.6 to 14.1 deaths per 1,000 live births between 2000 and 20132. Although many countries have made significant improvement, few are on the way to achieve the established goals. Many interventions have focused on priority causes, such as infectious and nutritional diseases 4-6, leaving aside deaths from external causes, despite being responsible for about one out of every twenty deaths in children under 5 years of age worldwide, which should be totally preventable8,9.

Since its origins back in 1953, the National Administrative Department of Statistics (DANE by its acronym in spanish) has been showing a progressive decrease in the number of deaths occurring in children under five years of age10, which is a fact that has been observed in all Latin American countries11,12.

Since 2005, all the general information on deaths, by gender, age and cause of death, has been presented in the DANE pages and has been gathered for analysis in the vital statistics information tables of SISPRO, the Ministry’s official Information System for Health and Social Protection of Colombia13. This report presents a secondary analysis of the data for the population under five years old, with emphasis on the group of deaths due to external causes, located in different regions of Colombia, during the years 2005 to 2013.

Patients and Method

All the information derived from death certificates is available both on the DANE portal and on the SISPRO* portal. This information can be organized using Excel tables, as well as using several filters. In this case, we grouped by different ages, which were grouped year by year and by department. From this pivotal table, the information for all patients under 5 years of age was extracted, making tables gathering information of everyone who met the criteria of every single year, from 2005 to 2013 (the original idea was to include 2014, but results were incomplete for this year). Then, a causal analysis was made, grouping them according to causal “groups”, into the three major disease categories of the Global Burden of Disease (GBD) study, and the Institute for Health Metrics and Evaluation (IHME)14. This classification is defined as: Group 1: infectious diseases, maternal and neonatal conditions, and nutritional deficiencies; Group 2: chronic noncommunicable diseases; and Group 3: external causes. External causes include traffic accidents, self-inflicted injuries, violence, armed conflict, and domestic accidents. For some causes of interest, individual tables were created, following the ICD-10 disease classification. Emphasis was placed on those causes of death considered preventable. This analysis was repeated for each department (region). From this information, descriptive statistical analyzes were performed to determine the progression of the change, if any, over the 9-year analysis. Within this group, children who died in traffic accidents (V80-89-land transport accidents), or who passed away drowned (W65-74-accidental drowning and submersion), burned (X76, X97, Y26 - exposure to smoke, fire and flames) and exposed to harmful substances (X40-49) or violent death (X85-Y09 - assaults, homicides), were included.

Results

During this period, 106,339 children under 5 years of age died in Colombia; from these, 85,897 (81%) died during their first year of life. There was a progressive decrease in the number of deaths, from 14,265 children under 5 years of age who died in 2005 to 9,499 in 2013 (equivalent to a 33% reduction in the annual number of children who died). The decrease in the death rate would be 19.4 to 14.1 for every 1,000 live births (a considerable decrease of 27%). This proportion of the reduction of deceased children was higher in Boyacá (from 406 children in 2005 to 154 in 2013, a 62% decrease), followed by Cauca (452 in 2005 to 229 in 2013, a 49% reduction), and Tolima (404 in 2005 to 218 in 2013, a decrease of 46%). Other regions that showed a reduction above 40% were, in decreasing order, Norte de Santander, Antioquia, Quindío, Huila, Cundinamarca and Risaralda.

There are significant disparities among regions. In the Andean region, the number of children that died decreased from 9,682 in 2005 to 5,990 in 2013 (a 38% of decrease). The Amazonia and Orinoquía regions together went from 789 children who died in 2005 to 531 in 2013 (reduction of 33%); while the Caribbean region showed the lowest decrease in its mortality: from 3,794 children in 2005, to 2,778 in 2013 (a reduction of 21.5%) (Table 1).

Table 1. Number of deaths in children under 5 years of age by department, in the period 2005-2013

There was a clear tendency to reduce the number of children who died in all regions of Colombia, with the exception of Amazonas, Guainía, La Guajira, San Andrés, and Vaupés (where we even found an increase). In many cases, it is not possible to determine the specific cause of death from death certificates, since the diagnosis is often not precise or detailed. Thus, during the period of this study, 7,044 children died from “other unspecified bacterial diseases”; 6.702 from “general signs and symptoms”; 5,836 from “other disorders originated in the perinatal period”; 877 from “other illness and unspecified causes of mortality”; 4,996 from “cardiac arrest” and another 963 from “respiratory arrest”. This is a matter of concern, as it could affect the validity of our analyzes of deaths from external causes. Such diagnoses as “asphyxia” (1,894 deaths), “head injuries”, in which it is not specified whether it was an assault or accident (726 deaths); as well as “traumatic shock” (1,270 deaths) are also very worrisome.

Those five external causes of death that were analyzed represented 4,043 children who died, equivalent to 3.8% of all deaths in this age group; 2,381 of these deaths (59%) occurred in males. From these, the main one is drowning by submersion. In this 9-year period, 1,749 children died (males 1,096, 63%), which is equivalent to an average of almost 4 per week. A decrease in the number of deaths is observed here: from 220 in 2005 and 241 in 2006, to 152 in 2012 and 151 in 2013 (Figure 1). This reduction is similar in deaths from traffic accidents, which went from 193 in 2005 to 184 in 2006, to 116 in 2012 and 101 in 2013. These accidents were the cause of death for 1,282 children (males 741; 58%) during this 9-year period. The third main cause of death are homicides, responsible for 328 girls and 364 boys (total 692), during this period. As shown in Figure 1, there is also a reduction, from 99 deaths in 2005 to 46 in 2013. Children who died from burns, who were 199 (males 116; 58%) showed the greatest reduction as well, from 38, 34 and 33 deaths in 2005, 2006 and 2007, respectively, these were reduced to 8 in 2011, 7 in 2012, and 9 in 2013.

Figure 1. Children under 5 years of age dieing from external causes, in the period 2005-2013.

Discussion and conclusions

Death certificates, as sources of information, have several limitations. The first is coverage, since all deaths are not necessarily recorded. According to a study made in 2000, the coverage of death certificates in Colombia was close to 80%, and the lack of registries affected mainly neonates, and the more remote rural areas.

Also, this lack of information affects some causes of death above others. This may lead to bias (due to underestimation), however, it is feasible that deaths from external causes (due to their legal implications, at least more than deaths from other causes) suffer less underreporting. It is important that doctors are aware of the major topic that means to create a death record, which is often seen, not as a source of vital information, but as a simple bureaucratic process.

The first interesting finding of this study is the progressive decrease of all causes of mortality, more noticeable in the Central region of Colombia than in the Caribbean region. This reduction in mortality is also observed in deaths from external causes, deaths that, although representing a little less than 4%, can produce traumatic consequences to the family of the deceased. There is still much that can be done in this area.

Several countries have designed strategies to reduce drowning deaths15, traffic accidents16 and intoxications17. Regarding Colombia, the restriction on the use of gunpowder18, as well as the extension of the use of household gas (in replacement of liquid hydrocarbon stoves, so common a couple of decades ago), must have contributed to the reduction of chil mortality, especially those who died by fire19. Although a huge progress has been made at the national level, not all regions of this country have benefited equitably. As in other socio-economic indicators, the Caribbean region is less favored. Although the inequality of these death rates was not analyzed in this study, it would be interesting to analyze the relationship of these external causes, with poverty or the educational level of parents.

We could conclude, then, that the challenges imposed by social development require more work in perinatal deaths, associated with poor obstetric care, and with infectious and nutritional diseases. Deaths from external causes should all be preventable and require interventions from different sectors require intersectoral interventions as they should be avoidable.

*NT: SISPRO is an acronym in Spanish for ‘Comprehensive Social Protection System’, or CSPS in english. It is decided to keep its spanish form, due to the context in which the term is applied.

References

 

1. World Health Organization. Health in the Millenium Development Goals. Geneva: WHO; 2005 [consultado 08-09-2016]. Disponible en: http://www.who.int/topics/millennium_development_goals/en/.         [ Links ]

2. Así vamos en salud. Tasa de mortalidad en menores de 5 años: Georeferenciado. 2016. [consultado 08-09-2016]. Disponible en: http://www.asivamosensalud.org/indicadores/estado-desalud/tasa-de-mortalidad-en-menores-de-5-anos-georeferenciado        [ Links ]

3. Shetty AK. Global maternal, newborn, and child health: Successes, challenges, and opportunities. Pediatr Clin North Am. 2016;63(1):1-18.         [ Links ]

4. McDougall L, Sharma A, Franz-Vasdeki J, Beattie AE, Touré K, Afsana K, et al. Prioritising women’s, children’s, and adolescents’ health in the post-2015 world. BMJ. 2015;351:h4327.         [ Links ]

5. Brown NJ, Platt MPW, Beattie RM. Women, children, and global public health: beyond the millennium development goals. BMJ. 2015;350.         [ Links ]

6. Cha S, Cho Y. Changes in under-5 mortality rate and major childhood diseases: A countrylevel analysis. Asia Pac J Public Health. 2016;28(2):178-96.         [ Links ]

7. Szot M. Mortalidad en el menor de 1 año por causas externas, Chile, 2000. Rev Chil Pediatr. 2003;74(5):492-8.         [ Links ]

8. Sidebotham P, Fraser J, Fleming P, Ward-Platt M, Hain R. Patterns of child death in England and Wales. Lancet. 2014;384(9946):904-14.         [ Links ]

9. Fraga AM, Fraga GP, Stanly C, Constantini TW, Coimbra R. Children at danger: injury fatalities among children in San Diego County. Eur J Epidemiol. 2010;25(3):211-7.         [ Links ]

10. Rosselli D, Tarazona N, Aroca A. La salud en Colombia 1953-2013: Un análisis de estadísticas vitales. Medicina (Bogotá). 2013;36(2):120-35.         [ Links ]

11. Victora CG, Barros FC. Global child survival initiatives and their relevance to the Latin American and Caribbean Region. Rev Panam Salud Pública. 2005;197-205.         [ Links ]

12. Organización Panamericana de la Salud. Situación de salud en las Américas - Indicadores Básicos 2015. [consultado 08-09-2016]. Disponible en: http://www.paho.org/uru/index.php?option=com_content&view=article&id=756:situacion-saludamericas- indicadores-basicos&Itemid=260        [ Links ]

13. Ministerio de Salud y Protección Social. SISPRO - Sistema Integral de Información de la Protección Social. 2016. [consultado 09-02-2016]. Disponible en: http://www.sispro.gov.co/        [ Links ]

14. Institute for Health Metrics and Evaluation, Human Development Network, The World Bank. The global burden of disease: Generating evidence, guiding policy - Latin America and Caribbean regional edition. Seattle, WA: IHME, 2013. [consultado 08-09-2016]. Disponible en: http://documents.worldbank.org/curated/en/501941468300696752/pdf/808510PUB0ENGL0Box 0379820B00PUBLIC0.pdf        [ Links ]

15. Wallis BA, Watt K, Franklin RC, Taylor M, Nixon JW, Kimble RM. Interventions associated with drowning prevention in children and adolescents: systematic literature review. BMJ. 2014;21(3):195-204.         [ Links ]

16. Barraco RD, Cheng JD, Bromberg WJ, Falcone R a., Hammond JS, Lui FY, et al. Child passenger safety: An evidence-based review. J Trauma Inj Infect Crit Care. 2010;69(6):1588-90.         [ Links ]

17. Hon KLE, Leung AKC. Childhood accidents: Injuries and poisoning. Adv Pediatr.2010;57(1):33-62.         [ Links ]

18. Chaparro-Narváez P, Cotes-Cantillo K, Castañeda-Orjuela C, De la Hoz-Restrepo F. Injuries due to fireworks use: A surveillance data analysis in Colombia, 2008-2013. Burns. 2016 Aug 27. pii: S0305-4179(16)30211-X. doi: 10.1016/j.burns.2016.07.005.         [ Links ]

19. Sierra-Zúñiga MF, Castro-Delgado OE, Caicedo-Caicedo JC, Merchán-Galvis AM, Delgado-Noguera M. Epidemiological profile of minor and moderate burn victims at the University Hospital San José, Popayán, Colombia, 2000-2010. Burns. 2013;39(5):1012-7.         [ Links ]

__________________

Received: 12-9-2016; Accepted: 8-11-2016

Ethical Responsibilities

Human Beings and animals protection: Disclosure the authors state that the procedures were followed according to the Declaration of Helsinki and the World Medical Association regarding human experimentation developed for the medical community.

Data confidentiality: The authors state that they have followed the protocols of their Center and Local regulations on the publication of patient data.

Rights to privacy and informed consent: The authors have obtained the informed consent of the patients and/or subjects referred to in the article. This document is in the possession of the correspondence author.

Financial Disclosure

This study did not receive any external financial su­pport.

Conflicts of Interest

Authors declare no conflict of interest regarding the present study.

Correspondencia a:

Diego Rosselli

diego.rosselli@gmail.com

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