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Muertes por afecciones abdominales agudas y acceso geográfico a la atención quirúrgica en la India: un análisis

Joshua S Ng-Kamstra¹, Anna J Dare¹, Jayadeep Patra¹

¹Centre for Global Health Research, St Michael's Hospital and University of Toronto, Toronto, ON, Canada.

Lancet (London, England)

|August 28, 2015

Resumen

Las muertes por afecciones abdominales agudas en la India están relacionadas con el acceso geográfico a la atención quirúrgica. La mejora de los recursos hospitalarios podría evitar más de 50.000 muertes anuales por estas condiciones.

Área de la Ciencia:

Salud global
Acceso a la atención quirúrgica
Política de salud pública

Sus antecedentes:

Las afecciones abdominales agudas tienen una alta mortalidad sin una intervención quirúrgica oportuna.
Existen datos limitados sobre la mortalidad por cirugía y el acceso en países de ingresos bajos y medios.
Los estudios sobre las muertes por AAD en la India son escasos.

Objetivo del estudio:

Analizar la distribución espacial y socioeconómica del DAA en la India.
Evaluar el acceso a las instalaciones quirúrgicas en relación con el DAA.
Informar las estrategias de salud pública para reducir la mortalidad quirúrgica.

Principales métodos:

Utilizó una encuesta de mortalidad nacionalmente representativa de 1,1 millones de hogares indios.
Datos de muertes vinculados a los datos de las instalaciones nacionales para el análisis geográfico.
Clustering espacial empleado (Getis-Ord Gi*) para identificar las zonas de alta mortalidad.
Comparación del acceso a la atención quirúrgica con buenos recursos en grupos de alta y baja mortalidad.

Principales resultados:

Se estima que hay 72,000 DAA a nivel nacional en la India (2010), con el 71% ocurriendo en el hogar y el 87% en las áreas rurales.
La enfermedad de úlcera péptica fue la causa principal (79%).
Los grupos de alta mortalidad estaban significativamente más alejados de los hospitales con buenos recursos (OR 4,4 para > 50 km, OR 16,1 para > 100 km).

Conclusiones:

La mejora de los recursos en los hospitales públicos es crucial para reducir el DAA en la India.
La mejora del acceso a hospitales con buenos recursos en un radio de 50 km podría evitar más de 50.000 muertes por AAD al año.
El enfoque en los servicios públicos es vital para los pobres, dados los altos gastos catastróficos de salud.

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