Infant mortality rates and pneumococcal vaccines: a time-series trend analysis in 194 countries, 1950-2020.

Pneumonia due to Streptococcus pneumoniae (pneumococcus) is a major cause of mortality in infants (children under 1 year of age), and pneumococcal conjugate vaccines (PCVs), delivered during the first year of life, are available since the year 2000. Given those two premises, the conclusion follows logically that favourable impact reported for PCVs in preventing pneumococcal disease should be reflected in the infant mortality rates (IMRs) from all causes. Using publicly available datasets, country-level IMR estimates from UNICEF and PCV introduction status from WHO, country-specific time series analysed the temporal relationship between annual IMRs and the introduction of PCVs, providing a unique context into the long-term secular trends of IMRs in countries that included and countries that did not include PCVs in their national immunisation programmes. PCV status was available for 194 countries during the period 1950-2020: 150 (77.3%) of these countries achieved nationwide PCV coverage at some point after the year 2000, 13 (6.7%) achieved only partial or temporary PCV coverage, and 31 (15.9%) never introduced PCVs to their population. One hundred and thirty-nine (92.7%) of countries that reported a decreasing (negative) trend in IMR, also reported a strong correlation with decreasing maternal mortality rates (MMRs), suggesting an improvement in overall child/mother healthcare. Conversely, all but one of the countries that never introduced PCVs in their national immunisation programme also reported a decreasing trend in IMR that strongly correlates with MMRs. IMRs have been decreasing for decades all over the world, but this latest decrease may not be related to PCVs.

Patient perspectives on the promptness and quality of care of road traffic incident victims in Peru: a cross-sectional, active surveillance study.

BACKGROUND: Road injuries are the second-leading cause of disease and injury in the Andean region of South America. Adequate management of road traffic crash victims is important to prevent and reduce deaths and serious long-term injuries. OBJECTIVE: To evaluate the promptness of health care services provided to those injured in road traffic incidents (RTIs) and the satisfaction with those services during the pre-hospital and hospital periods. METHODS: We conducted a cross-sectional study with active surveillance to recruit participants in emergency departments at eight health care facilities in three Peruvian cities: a large metropolitan city (Lima) and two provincial cities (an urban center in the southern Andes and an urban center in the rainforest region), between August and September 2009. The main outcomes of interest were promptness of care, measured by time between injury and each service offered, as well as patient satisfaction measured by the Service Quality (SERVQUAL) survey. We explored the association between outcomes and city, type of health care facility (HCF), and type of provider. RESULTS: We recruited 644 adults seeking care for RTIs. This active surveillance strategy yielded 34% more events than anticipated, suggesting under-reporting in traditional registries. Median response time between a RTI and any care at a HCF was 33 minutes overall and only 62% of participants received professional care during the initial "golden" hour after the RTI. After adjustment for various factors, there was strong evidence of higher global dissatisfaction levels among those receiving care at public HCFs compared to private ones (odds ratio (OR) 5.05, 95% confidence interval (CI) 1.88-13.54). This difference was not observed when provincial sites were compared to Lima (OR 1.41, 95% CI 0.42-4.70). CONCLUSIONS: Response time to RTIs was adequate overall, though a large proportion of RTI victims could have received more prompt care. Overall, dissatisfaction was high, mainly at public institutions indicating much need for improvements in service provision.

Estimación del costo oportunidad en el que incurre el Hospital Nacional Cayetano Heredia por parto eutócico no complicado 2007 / Determining cost-opportunity incurred by Hospital Nacional Cayetano Heredia in normal vaginal deliveries attention 2007

Objetivo: Identificar el costo oportunidad en el que incurre el Hospital Nacional Cayetano Heredia (HNCH) por atención de parto eutócico no complicado. Diseño: Estudio fue de tipo descriptivo, transversal, observacional. Institución: Departamento de Gineco Obstetricia, Hospital Nacional Cayetano Heredia, Lima, Perú. Material: Historias clínicas de gestantes atendidas con partos eutócicos no complicados. Intervenciones: Se revisó las historias clínicas de 2 700 partos eutócicos no complicados atendidos durante el periodo enero a diciembre de 2007, los cuales fueron distribuidos de acuerdo a la modalidad de financiamiento de los mismos, pago vía Sistema Integral de Salud (SIS) y pago de bolsillo; además, se consideró los casos rechazados por el SIS. El análisis estadístico se realizó en software comercial. Principales medidas de resultados: Costo sombra, costo oportunidad por SIS, gasto de bolsillo, monto por casos rechazados por el SIS. Resultados: El monto total del costo sombra de todos los partos eutócicos no complicados fue S/. 1.1016.880.5 nuevos soles, el costo oportunidad por SIS fue S/.243.197.9 nuevos soles y por gasto de bolsillo S/.32.131.0 nuevos soles; el monto por los casos rechazados por SIS ascendió a S/.107.434.6 nuevos soles. La falta de reembolso del SIS al HNCH fue 10,54% de todos los partos eutócicos no complicados que ingresaron por SIS en el año 2007. Conclusiones: Se encontró que 78% de los partos vaginales espontáneos fueron partos eutócicos no complicados; esto representó que el HNCH estaría realizando producción de otro nivel de resolutividad; basados en el costo sombra, se generó una falta de ingreso de S/. 741.551.60 soles en el año 2007.

Objective: To identify cost-opportunity that Hospital Nacional Cayetano Heredia (HNCH) presents for spontaneous normal vaginal deliveries. Design: Descriptive, transversal, observational study. Setting: Department of Gynecology and Obstetrics, Hospital Nacional Cayetano Heredia, Lima, Peru. Material: Clinical charts of patients attended for non complicated vaginal deliveries. Interventions: Clinical charts of 2 700 normal vaginal deliveries attended from January through December 2007 were reviewed and distributed according to mode of financing either by Sistema Integral de Salud (SIS) or by pocket payment; also SIS rejected cases were considered. Statistical analysis was done with commercial software. Main outcome measures: Shadow cost, costopportunity by SIS, pocket expense, cases rejected by SIS. Results: The total cost for spontaneous normal vaginal deliveries attended at HNCH was S/. 1.1016.880.5 nuevos soles, cost-opportunity by SIS was S/. 243.197.9 nuevos soles and for full payment mode S/. 32.131.0 nuevos soles. Losses for SIS rejections were S/.107.434.6 soles. The lack of SIS refund to HNCH constituted 10.54% of all spontaneous normal vaginal deliveries admitted by SIS during the year 2007. Conclusions: Seventy eight per cent of spontaneous vaginal deliveries are non complicated deliveries, which means that HNCH is performing other resolutivity resolution level; based in the shadow price, a loss of S/. 741.551.6 nuevos soles was generated in 2007.