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[List of potentially avoidable causes of death in childhood: a proposal for Colombia]
Maylen Liseth Rojas-Botero1, Yadira Eugenia Borrero-Ramírez1, Flor de María Cáceres-Manrique2
1Facultad Nacional de Salud Pública, Universidad de Antioquia, Medellín, Colombia.
Insights
Colombia developed a list of avoidable childhood deaths to improve public health. This inventory helps estimate and track deaths that could be prevented by better disease prevention and healthcare services.
Area of Science:
- Public Health
- Pediatrics
- Epidemiology
Background:
- Avoidable mortality is a critical public health indicator.
- Colombia lacks a comprehensive inventory for childhood avoidable mortality.
- Estimating avoidable deaths guides public health interventions.
Purpose of the Study:
- To propose a list of potentially avoidable causes of death in children under five years of age in Colombia.
- To establish a consensus among experts on the avoidability of childhood deaths.
- To create a tool for public health decision-making in Colombia.
Main Methods:
- Evaluation of 6,800 causes of death based on three reference lists.
- Application of the Delphi method for expert consensus on 1,751 causes.
- Validation of causes through two rounds of expert evaluation, calculating agreement and Fleiss kappa.
- Categorization of causes into treatable, preventable, or mixed groups.
Main Results:
- A total of 6,168 potentially avoidable causes of death in children under five were identified.
- Causes were categorized as preventable (47.4%), treatable (39.5%), or mixed (13.1%).
- A strong consensus was achieved among pediatric experts regarding the avoidability of these causes.
Conclusions:
- The developed list of potentially avoidable causes of death is satisfactory for the Colombian context.
- This inventory can significantly aid in reducing childhood mortality through targeted interventions.
- The findings support the implementation of this list for public health policy and practice in Colombia.
Abstract:
Avoidable mortality is a key indicator for decision-making in public health, considering deaths that could be avoided by disease prevention and healthcare services. Colombia lacks a specific inventory that allows estimating the magnitude, distribution, and evolution of avoidable childhood mortality. The study thus aimed to propose a list of potentially avoidable causes of death in children under five years of age in Colombia. Based on three lists of avoidable childhood mortality, the authors evaluated 6,800 causes of death according to their potential avoidability in Colombia. After analyzing the etiological plausibility and according to the natural history of the diseases, 595 events were ruled out. Later, causes that appeared in at least two reference inventories were added to the list. For those contained in just one inventory, (1,751) the conventional Delphi method with two stages was applied to assess consensus among experts. All the resulting causes were assigned to an avoidability group and validated twice. In each round, the percentage of overall agreement and Fleiss kappa were calculated for multiple evaluators. In all, 6,168 potentially avoidable causes of death were evaluated in children under five years of age, categorized as treatable (39.5%), preventable (47.4%), or mixed (13.1%). A consensus was found among pediatric experts as to potential avoidability. The final set is satisfactory, and its use is recommended in the Colombian context.
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