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Gálvez JM, Pinzón-Rondón ÁM, Chaparro-Solano HM, Tovar-Romero HV, Ramírez-Prieto J, Ortigoza-Espitia SA, Ruiz-Sternberg ÁM. Effectiveness of the Booster Dose in Protecting against COVID-19, Colombia 2022. Vaccines (Basel) 2023; 11:1461. [PMID: 37766137 PMCID: PMC10538081 DOI: 10.3390/vaccines11091461] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2023] [Revised: 07/29/2023] [Accepted: 07/30/2023] [Indexed: 09/29/2023] Open
Abstract
Vaccination has proven to be one of the most effective strategies against the COVID-19 pandemic. Several studies have evaluated and confirmed its effectiveness in different populations, particularly in reducing severe outcomes such as hospitalization and death. Some studies have investigated the effectiveness of vaccination against the infection, identifying the need for booster doses. This study aimed to explore the effectiveness of the vaccination schedule on the probability of infection in a sample of Colombian patients during the fourth wave of the COVID-19 pandemic, which was associated with the emergence and predominance of the Omicron variant. A cross-sectional study was conducted on individuals who underwent RT-PCR testing for COVID-19 detection in a dedicated laboratory in Bogotá, Colombia, between 30 December 2021 and 7 February 2022. A total of 1468 subjects was included in the study, of whom 36.6% (n = 538) had a positive PCR test for COVID-19. The comparison between fully vaccinated individuals with a booster dose and those without the booster dose revealed a 28% reduction in the odds of infection (OR = 0.719 CI 0.531-0.971). Age (OR = 1.009 CI 1.001-1.018) and low economic status (OR = 1.812 CI 1.416-2.319) were associated with an increased risk of infection. These findings suggest the need for a booster vaccination in the general population to improve the prevention rates of SARS-CoV-2 infection and mitigate severe outcomes.
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Affiliation(s)
| | | | | | | | - Juliana Ramírez-Prieto
- Clinical Investigation Group, Universidad del Rosario, Carrera 24 #63C-69, Bogotá 111221, Colombia
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Gálvez JM, Chaparro-Solano HM, Pinzón-Rondón ÁM, Albornoz LL, Pardo-Oviedo JM, Zapata-Gómez FA, Patiño-Aldana AF, Hernández-Rodríguez ADP, Díaz-Quiroz M, Ruiz-Sternberg ÁM. Mutation profile of SARS-CoV-2 genome in a sample from the first year of the pandemic in Colombia. Infect Genet Evol 2022; 97:105192. [PMID: 34933126 PMCID: PMC8684288 DOI: 10.1016/j.meegid.2021.105192] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/15/2021] [Revised: 11/18/2021] [Accepted: 12/14/2021] [Indexed: 10/25/2022]
Abstract
The severe acute respiratory syndrome coronavirus type 2 (SARS-CoV-2) is the etiopathogenic agent of COVID-19, a condition that has led to a formally recognized pandemic by March 2020 (World Health Organization -WHO). The SARS-CoV-2 genome is constituted of 29,903 base pairs, that code for four structural proteins (N, M, S, and E) and more than 20 non-structural proteins. Mutations in any of these regions, especially in those that encode for the structural proteins, have allowed the identification of diverse lineages around the world, some of them named as Variants of Concern (VOC) and Variants of Interest (VOI), according to the WHO and CDC. In this study, by using Next Generation Sequencing (NGS) technology, we sequenced the SARS-CoV-2 genome of 422 samples from Colombian residents, all of them collected between April 2020 and January 2021. We obtained genetic information from 386 samples, leading us to the identification of 14 new lineages circulating in Colombia, 13 of which were identified for the first time in South America. GH was the predominant GISAID clade in our sample. Most mutations were either missense (53.6%) or synonymous mutations (37.4%), and most genetic changes were located in the ORF1ab gene (63.9%), followed by the S gene (12.9%). In the latter, we identified mutations E484K, L18F, and D614G. Recent evidence suggests that these mutations concede important particularities to the virus, compromising host immunity, the diagnostic test performance, and the effectiveness of some vaccines. Some important lineages containing these mutations are the Alpha, Beta, and Gamma (WHO Label). Further genomic surveillance is important for the understanding of emerging genomic variants and their correlation with disease severity.
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Affiliation(s)
| | - Henry Mauricio Chaparro-Solano
- Genuino Research Group, Gencell Pharma, Colombia; Clinical Investigation Group, Universidad del Rosario, Colombia; Hospital Universitario Mayor - Méderi, Colombia
| | | | | | - Juan Mauricio Pardo-Oviedo
- Clinical Investigation Group, Universidad del Rosario, Colombia; Hospital Universitario Mayor - Méderi, Colombia
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Ruiz-Sternberg ÁM, Chaparro-Solano HM, Albornoz LLA, Pinzón-Rondón ÁM, Pardo-Oviedo JM, Molano-González N, Otero-Rodríguez DA, Zapata-Gómez FA, Gálvez-Bermúdez JM. GENOMIC CHARACTERIZATION OF SARS-CoV-2 AND ITS ASSOCIATION WITH CLINICAL OUTCOMES: A ONE-YEAR LONGITUDINAL STUDY OF THE PANDEMIC IN COLOMBIA. Int J Infect Dis 2021; 116:91-100. [PMID: 34920122 PMCID: PMC8673727 DOI: 10.1016/j.ijid.2021.12.326] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2021] [Revised: 11/10/2021] [Accepted: 12/08/2021] [Indexed: 01/08/2023] Open
Abstract
Objectives This study aimed to explore associations between the molecular characterization of severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) and disease severity in ambulatory and hospitalized patients in two main Colombian epicentres during the first year of the coronavirus disease 2019 pandemic. Methods In total, 1000 patients with SARS-CoV-2 infection were included in this study. Clinical data were collected from 997 patients, and 678 whole-genome sequences were obtained by massively parallel sequencing. Bivariate, multi-variate, and classification and regression tree analyses were run between clinical and genomic variables. Results Age >88 years, and infection with lineages B.1.1, B.1.1.388, B.1.523 or B.1.621 for patients aged 71–88 years were associated with death [odds ratio (OR) 6.048036, 95% confidence interval (CI) 1.346567–32.92521; P=0.01718674]. The need for hospitalization was associated with higher age and comorbidities. The hospitalization rate increased significantly for patients aged 38–51 years infected with lineages A, B, B.1.1.388, B.1.1.434, B.1.153, B.1.36.10, B.1.411, B.1.471, B.1.558 or B.1.621 (OR 8.368427, 95% CI 2.573145–39.10672, P=0.00012). Associations between clades and clinical outcomes diverged from previously reported data. Conclusions Infection with lineage B.1.621 increased the hospitalization and mortality rates. These findings, plus the rapidly increasing prevalence in Colombia and other countries, suggest that lineage B.1.621 should be considered as a ‘variant of interest’. If associated disease severity is confirmed, possible designation as a ‘variant of concern’ should be considered.
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Affiliation(s)
| | - Henry Mauricio Chaparro-Solano
- Clinical Investigation Group, Universidad del Rosario, Carrera 24 # 63C-69, Bogotá, Colombia; Genuino Research Group, Gencell Pharma, Calle 82 # 18 - 12, Bogotá, Colombia; Hospital Universitario Mayor - Méderi, Calle 24 # 29 - 45, Bogotá, Colombia.
| | - Ludwig Luis Antonio Albornoz
- Departamento de Patología y Medicina de Laboratorio, Fundación Valle del Lili, Carrera 98 # 18 - 49, Cali, Colombia; Facultad de Ciencias de la Salud, Universidad ICESI, Calle 18 # 122 - 135, Cali, Colombia.
| | | | - Juan Mauricio Pardo-Oviedo
- Clinical Investigation Group, Universidad del Rosario, Carrera 24 # 63C-69, Bogotá, Colombia; Hospital Universitario Mayor - Méderi, Calle 24 # 29 - 45, Bogotá, Colombia.
| | - Nicolás Molano-González
- Clinical Investigation Group, Universidad del Rosario, Carrera 24 # 63C-69, Bogotá, Colombia.
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Botero-Meneses JS, Aguilera-Otalvaro PA, Pradilla I, Talero-Gutiérrez C, Ruiz-Sternberg ÁM, Vélez-van-Meerbeke A, Pinzón-Rondón AM. Assessment of nutrition and learning skills in children aged 5-11 years old from two elementary schools in Chocó, Colombia. Heliyon 2020; 6:e03821. [PMID: 32346641 PMCID: PMC7182721 DOI: 10.1016/j.heliyon.2020.e03821] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2019] [Revised: 12/19/2019] [Accepted: 04/17/2020] [Indexed: 11/26/2022] Open
Abstract
Background Malnutrition has been identified as a factor in growth and learning. The current study aimed to determine the nutritional status and basic learning skills of children from Chocó, Colombia. Methods We conducted a cross-sectional study of 631 children aged 5-11 years from two schools, collecting anthropometric measurements, nutritional quality surveys and sociodemographic data. Neuropsychological batteries were applied. Results A total of 523 children were evaluated, with an average age of 8.49 ± 2.1 years. The results revealed that 2.9% of children were underweight, 0.4% were severely underweight, and 4.8% were diagnosed as having stunted growth. In addition, 71.8% of children were unable to draw a human figure. Beery-Buktenica Visual-Motor Integration test (VMI) performance was below the scores expected for these age groups in 73.9% of children. Battery of Differential and General Abilities (BADYG) performance revealed limited verbal skills. In a subsample of 117 children, anemia was detected in 12.8% of cases, and iron deficiency was present in 44.4% of cases. Global malnutrition was associated with impairments in BADYG performance (OR: 1.98; 95% CI: 1.07-3.86). Conclusions The current results revealed that learning performance was below the expected level for children in these age groups across all of the applied tests. Although malnutrition could partially explain the poor performance of children in tests of learning abilities, additional factors are likely to be involved.
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Affiliation(s)
- Juan Sebastián Botero-Meneses
- Neuroscience Research Group (NeURos), Escuela de Medicina y Ciencias de la Salud, Universidad del Rosario, Bogotá D.C. Colombia, 111211
| | - Paula Andrea Aguilera-Otalvaro
- Grupo de Investigación Clínica (Clinical Investigation Research Group), Escuela de Medicina y Ciencias de la Salud, Universidad del Rosario, Bogotá D.C. Colombia, 111211
| | - Iván Pradilla
- Neuroscience Research Group (NeURos), Escuela de Medicina y Ciencias de la Salud, Universidad del Rosario, Bogotá D.C. Colombia, 111211
| | - Claudia Talero-Gutiérrez
- Neuroscience Research Group (NeURos), Escuela de Medicina y Ciencias de la Salud, Universidad del Rosario, Bogotá D.C. Colombia, 111211
| | - Ángela María Ruiz-Sternberg
- Grupo de Investigación Clínica (Clinical Investigation Research Group), Escuela de Medicina y Ciencias de la Salud, Universidad del Rosario, Bogotá D.C. Colombia, 111211
| | - Alberto Vélez-van-Meerbeke
- Neuroscience Research Group (NeURos), Escuela de Medicina y Ciencias de la Salud, Universidad del Rosario, Bogotá D.C. Colombia, 111211
| | - Angela María Pinzón-Rondón
- Grupo de Investigación Clínica (Clinical Investigation Research Group), Escuela de Medicina y Ciencias de la Salud, Universidad del Rosario, Bogotá D.C. Colombia, 111211
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Isaza-Restrepo A, Quintero-Contreras JA, Escobar-DiazGranados J, Ruiz-Sternberg ÁM. Value of clinical examination in the assessment of penetrating neck injuries: a retrospective study of diagnostic accuracy test. BMC Emerg Med 2020; 20:17. [PMID: 32151240 PMCID: PMC7063736 DOI: 10.1186/s12873-020-00311-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2019] [Accepted: 02/14/2020] [Indexed: 12/04/2022] Open
Abstract
Background There are many high-volume trauma centers in limited resource environments where a thorough clinical examination of patients may contribute to a more economical, accurate, and widely applicable method of determining the proper management of patients with penetrating neck injuries. The purpose of this study was to validate thorough physical examination as a reliable diagnostic tool in these patients. Methods We performed an observational retrospective study of a diagnostic accuracy test where we compared clinical findings (symptoms and soft signs on admission of the patient) with the definitive findings according to the gold standard test for each particular situation (selective studies, clinical observation and surgical exploration). The study was conducted at Hospital Occidente Kennedy (HOK) between August 2009 and June 2010. Results The sample consisted of the clinical records of 207 (n = 207) patients who went to the emergency room for penetrating neck wounds at Hospital Occidente Kennedy (HOK). Of the total sample, 36.2% (n = 75) of patients were considered “asymptomatic” as they didn’t present with any soft signs of injury. Vascular soft signs were present in 57% (n = 118) of the patients, soft signs of the airway and the upper gastrointestinal tract were present in 15.9% (n = 33) and 21.3% (n = 44) of the patients respectively. The sensitivity and negative predictive value (NPV) of any soft sign to determine injuries which require surgical repair was 97.4% [CI] [86.5–99.5%] and 98.7% [CI] [92.8–99.8%] respectively, with a range of confidence [CI] of 95%. Conclusions Our study’s main findings suggest that patients with neck injuries and no vascular, airway, or gastrointestinal soft sign can be safely managed with a conservative approach. It is important to emphasize the value of the clinical examination since there are many contexts in the modern world where a considerable amount of the population is afflicted by neck trauma and treated under conditions where technological resources are limited.
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Affiliation(s)
- Andrés Isaza-Restrepo
- Escuela de Medicina y Ciencias de la Salud. Grupo de Investigación Clínica, Universidad del Rosario, Carrera 24 No 63C-69 Barrio Siete de Agosto, Bogotá, DC, Colombia. .,Méderi Hospital Universitario Mayor, Bogotá, DC, Colombia.
| | | | - Jorge Escobar-DiazGranados
- Escuela de Medicina y Ciencias de la Salud. Grupo de Investigación Clínica, Universidad del Rosario, Carrera 24 No 63C-69 Barrio Siete de Agosto, Bogotá, DC, Colombia
| | - Ángela María Ruiz-Sternberg
- Escuela de Medicina y Ciencias de la Salud. Grupo de Investigación Clínica, Universidad del Rosario, Carrera 24 No 63C-69 Barrio Siete de Agosto, Bogotá, DC, Colombia
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Pinzón-Rondón ÁM, Hoyos-Martínez A, Parra-Correa D, Pedraza-Flechas AM, Ruiz-Sternberg ÁM. Association of nutritional support programs with zinc deficiency in Colombian children: a cross-sectional study. BMC Nutr 2019; 5:42. [PMID: 32153955 PMCID: PMC7050802 DOI: 10.1186/s40795-019-0305-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2018] [Accepted: 08/06/2019] [Indexed: 01/13/2023] Open
Abstract
Background Zinc is an essential trace element that plays a key role in the immune, gastrointestinal, respiratory and nervous systems. In Colombia, a vast percentage of children live in low-income households with food insecurity and nutritional deficiencies, including zinc. In an effort to improve children’s well-being, public health measures such as nutritional support programs that provide meals have targeted the poorest populations. The aim of the present study was to assess the role of nutritional support programs on zinc deficiency in Colombian children, while considering their wealth and food security. Methods Cross-sectional study using data from the 2010 Colombian National Nutrition Survey, a population-based study representative of Colombia. A total of 4275 children between 12 and 59 months of age were included in the study. Stepwise logistic regressions were modelled with SPSS, first for zinc deficiency on wealth and food security, then adding enrolment in a nutritional support program, and finally, adjusting for socio-demographic variables. Results A zinc deficiency prevalence of 49% was found. The adjusted models showed an association of wealth quintiles: very poor (OR = 1.48) and poor (OR = 1.39), food security (OR = 0.75) and enrolment in a nutritional support program (OR = 0.76) with zinc deficiency. Enrolment in nutritional programs did not modify the relationship of wealth and food security to zinc deficiency. Conclusion Zinc deficiency is associated with wealth, food security and enrolment in nutritional support programs. Nutritional programs may be a good alternative against zinc deficiency, if they focus appropriately on the needs of children according to their wealth and food security.
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Affiliation(s)
- Ángela María Pinzón-Rondón
- 1Grupo de investigación clínica. Escuela de Medicina y Ciencias de la Salud, Universidad del Rosario sede Quinta de Mutis, Carrera 24 #6 3C-69, Bogotá, Colombia
| | | | - Daniela Parra-Correa
- 3Grupo de Salud Pública. Escuela de Medicina y Ciencias de la Salud, Universidad del Rosario, Bogotá, Colombia
| | - Ana María Pedraza-Flechas
- 1Grupo de investigación clínica. Escuela de Medicina y Ciencias de la Salud, Universidad del Rosario sede Quinta de Mutis, Carrera 24 #6 3C-69, Bogotá, Colombia
| | - Ángela María Ruiz-Sternberg
- 1Grupo de investigación clínica. Escuela de Medicina y Ciencias de la Salud, Universidad del Rosario sede Quinta de Mutis, Carrera 24 #6 3C-69, Bogotá, Colombia
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Ruiz-Sternberg ÁM, Moreira ED, Restrepo JA, Lazcano-Ponce E, Cabello R, Silva A, Andrade R, Revollo F, Uscanga S, Victoria A, Guevara AM, Luna J, Plata M, Dominguez CN, Fedrizzi E, Suarez E, Reina JC, Ellison MC, Moeller E, Ritter M, Shields C, Cashat M, Perez G, Luxembourg A. Efficacy, immunogenicity, and safety of a 9-valent human papillomavirus vaccine in Latin American girls, boys, and young women. Papillomavirus Res 2018; 5:63-74. [PMID: 29269325 PMCID: PMC5887018 DOI: 10.1016/j.pvr.2017.12.004] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/20/2017] [Revised: 12/11/2017] [Accepted: 12/15/2017] [Indexed: 11/22/2022]
Abstract
BACKGROUND A 9-valent human papillomavirus (HPV6/11/16/18/31/33/45/52/58; 9vHPV) vaccine was developed to expand coverage of the previously developed quadrivalent (HPV6/11/16/18; qHPV) vaccine. METHODS Efficacy, immunogenicity, and safety outcomes were assessed in Latin American participants enrolled in 2 international studies of the 9vHPV vaccine, including a randomized, double-blinded, controlled with qHPV vaccine, efficacy, immunogenicity, and safety study in young women aged 16-26 years, and an immunogenicity and safety study in girls and boys aged 9-15 years. Participants (N=5312) received vaccination at Day 1, Month 2, and Month 6. Gynecological swabs were collected regularly in young women for cytological and HPV DNA testing. Serum was analyzed for HPV antibodies in all participants. Adverse events (AEs) were also monitored in all participants. RESULTS The 9vHPV vaccine prevented HPV 31-, 33-, 45-, 52-, and 58-related high-grade cervical, vulvar, and vaginal dysplasia with 92.3% efficacy (95% confidence interval 54.4, 99.6). Anti-HPV6, 11, 16, and 18 geometric mean titers at Month 7 were similar in the 9vHPV and qHPV vaccination groups. Anti-HPV antibody responses following vaccination were higher among girls and boys than in young women. Most (>99%) 9vHPV vaccine recipients seroconverted for all 9 HPV types at Month 7. Antibody responses to the 9 HPV types persisted over 5 years. The most common AEs were injection-site related, mostly of mild to moderate intensity. CONCLUSIONS The 9vHPV vaccine is efficacious, immunogenic, and well tolerated in Latin American young women, girls, and boys. These data support 9vHPV vaccination programs in Latin America, a region with substantial cervical cancer burden.
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Affiliation(s)
| | - Edson D Moreira
- Associação Obras Sociais Irmã Dulce and Oswaldo Cruz Foundation, Brazilian Ministry of Health, Bahia, Brazil
| | | | - Eduardo Lazcano-Ponce
- Research Center on Public Health, National Institute of Public Health, Cuernavaca, Morelos, Mexico
| | | | | | - Rosires Andrade
- Departamento de Tocoginecologia da Universidade Federal do Paraná, Curitiba, Brazil
| | - Francisco Revollo
- Centro de Investigaciones, Hospital Universitario San Ignacio, Bogotá, Colombia
| | - Santos Uscanga
- Arké Estudios Clínicos S.A. de C.V., Mexico City, Mexico
| | - Alejandro Victoria
- Department of Obstetrics and Gynecology, Fundacion Valle del Lili, Cali, Colombia
| | | | - Joaquín Luna
- Departamento de Ginecología y Obstetricia Clínica Colsanitas, Fundación Universitaria Sanitas, Bogotá, Colombia
| | - Manuel Plata
- Department of Gynecology, Fundación Cardioinfantil, Bogotá, Colombia
| | | | - Edison Fedrizzi
- Department of Gynecology and Obstetrics, University of Santa Catarina, Florianópolis, Santa Catarina, Brazil
| | - Eugenio Suarez
- Gynecological Oncology Division Hospital Clinico San Borja Arriaran Universidad de Chile Campus Centro, Santiago, Chile
| | - Julio C Reina
- Department of Pediatrics, Universidad del Valle and Centro Medico Imbanaco, Cali, Colombia
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Pinzón-Rondón ÁM, Zárate-Ardila C, Hoyos-Martínez A, Ruiz-Sternberg ÁM, Vélez-van-Meerbeke A. Country characteristics and acute diarrhea in children from developing nations: a multilevel study. BMC Public Health 2015; 15:811. [PMID: 26293136 PMCID: PMC4546125 DOI: 10.1186/s12889-015-2120-8] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2014] [Accepted: 08/04/2015] [Indexed: 11/30/2022] Open
Abstract
Background Each year 2.5 billion cases of diarrheal disease are reported in children under five years, and over 1,000 die. Country characteristics could play a role on this situation. We explored associations between country characteristics and diarrheal disease in children under 5 years of age, adjusting by child, mother and household attributes in developing countries. Methods This study included 348,706 children from 40 nations. We conducted a multilevel analysis of data from the Demographic and Health Surveys and the World Bank. Results The prevalence of acute diarrhea was 14 %. Country inequalities (OR = 1.335; 95 % CI 1.117–1.663) and country’s low income (OR = 1.488; 95 % CI 1.024–2.163) were associated with diarrhea, and these country characteristics changed the associations of well-known determinants of diarrhea. Specifically, living in poor countries strengthens the association of poor household wealth and mother’s lack of education with the disease. Other factors associated with diarrhea were female sex of the child (OR = 0.922; 95 % CI 0.900–0.944), age of the child (OR = 0.978; 95 % CI 0.978–0.979), immunization status (OR = 0.821; 95 % CI 0.799–0.843), normal birthweight (OR = 0.879; 95 % CI 0.834–0.926), maternal age (OR = 0.987; 95 % CI 0.985–0.989), lack of maternal education (OR = 1.416; 95 % CI 1.283–1.564), working status of the mother (OR = 1.136; 95 % CI 1.106–1.167), planned pregnancy (OR = 0.774; 95 % CI 0.753–0.795), a nuclear family structure (OR = 0.949; 95 % CI 0.923–0.975), and household wealth (OR = 0.948; 95 % CI 0.921–0.977). Conclusions Inequalities and lack of resources at the country level in developing countries -but not health expenditure- were associated with acute diarrhea, independently of child, family and household features. The broad environment considerably modifies well-known social determinants of acute diarrhea and public health campaigns designed to target diarrhea should consider macro characteristics of the country.
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Affiliation(s)
- Ángela María Pinzón-Rondón
- Escuela de Medicina y Ciencias de la Salud, Universidad del Rosario, Bogotá, Colombia. .,Facultad de Medicina, Universidad del Rosario sede Quinta de Mutis, Carrera 24 #63C-69, Bogotá, Colombia.
| | - Carol Zárate-Ardila
- Escuela de Medicina y Ciencias de la Salud, Universidad del Rosario, Bogotá, Colombia.
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