Armed conflict and infant mortality due to diarrhea in colombian children
Conflicto armado y mortalidad infantil por diarrea en niños colombianos
Alvis Guzman, N
De la Hoz Restrepo, F
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AbstractObjectives We aimed to explore infant mortality due to Acute Diarrheal Disease (ADD), and its relationship with the armed conflict in Colombia. Methods We extracted mortality data from death certificates of the National Administrative Department of Statistics (DANE, in Spanish) using the codes A00-A09 from ICD-10. We excluded deaths with missing data. We used population projections from 2005 DANE census. We estimated municipality mortality rates related to ADD (MR-ADD) by sex in children under-five. Then, we calculated for 1998-2003, 2004-2009 and 2010-2015 the average annual mortality rate by quintiles of armed conflict intensity (ACI) at municipal level, following the ACI index built by the National Institute of Health of Colombia. Rate ratios were estimated to evaluate relative inequalities, such as the ratio between the quintile mortality rate of the higher ACI (more conflict intensity) and the lowest one. Results MR-ADD in children under-five were higher in boys than in girls, for all the periods studied. There was a decrease in the MR-ADD during the three periods for all ACI quintiles. A gradient pattern was evident according to the intensity of the conflict in all periods and for both sexes, with higher mortality rates in the quintile with the greatest impact due to the conflict. These inequality gaps showed that in children, for 1998-2003, the MR-ADD related to the quintile with the highest ACI was 1.64 times greater than the rate of quintile 1. For 2004-2009, this gap increased to 2.67 times and in 2010-2015, this relative difference was 2.78. In girls, rate ratios among the extreme quintiles were 1.75, 2.56 and 3.13, respectively. Conclusions Our results showed a close relationship between armed conflict and MR-ADD in children under-five, with a clear gradient pattern according to the ACI and bigger inequalities during the period analyzed, in spite of the decreasing in the mortality rates.