Primary health care contribution to improve health outcomes in Bogota-Colombia: a longitudinal ecological analysis
<p>Abstract</p> <p>Background</p> <p>Colombia has a highly segmented and fragmented national health system that contributes to inequitable health outcomes. In 2004 the district government of Bogota initiated a Primary Health Care (PHC) strategy to improve health care ac...
| Main Authors: | , , , , , , |
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| Format: | Article |
| Language: | English |
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BMC
2012-08-01
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| Series: | BMC Family Practice |
| Subjects: | |
| Online Access: | http://www.biomedcentral.com/1471-2296/13/84 |
| _version_ | 1811318341229346816 |
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| author | Mosquera Paola A Hernández Jinneth Vega Román Martínez Jorge Labonte Ronald Sanders David Sebastián Miguel |
| author_facet | Mosquera Paola A Hernández Jinneth Vega Román Martínez Jorge Labonte Ronald Sanders David Sebastián Miguel |
| author_sort | Mosquera Paola A |
| collection | DOAJ |
| description | <p>Abstract</p> <p>Background</p> <p>Colombia has a highly segmented and fragmented national health system that contributes to inequitable health outcomes. In 2004 the district government of Bogota initiated a Primary Health Care (PHC) strategy to improve health care access and population health status. This study aims to analyse the contribution of the PHC strategy to the improvement of health outcomes controlling for socioeconomic variables.</p> <p>Methods</p> <p>A longitudinal ecological analysis using data from secondary sources was carried out. The analysis used data from 2003 and 2007 (one year before and 3 years after the PHC implementation). A Primary Health Care Index (PHCI) of coverage intensity was constructed. According to the PHCI, localities were classified into two groups: high and low coverage. A multivariate analysis using a Poisson regression model for each year separately and a Panel Poisson regression model to assess changes between the groups over the years was developed. Dependent variables were infant mortality rate, under-5 mortality rate, infant mortality rate due to acute diarrheal disease and pneumonia, prevalence of acute malnutrition, vaccination coverage for diphtheria, pertussis, tetanus (DPT) and prevalence of exclusive breastfeeding. The independent variable was the PHCI. Control variables were sewerage coverage, health system insurance coverage and quality of life index.</p> <p>Results</p> <p>The high PHCI localities as compared with the low PHCI localities showed significant risk reductions of under-5 mortality (13.8%) and infant mortality due to pneumonia (37.5%) between 2003 and 2007. The probability of being vaccinated for DPT also showed a significant increase of 4.9%. The risk of infant mortality and of acute malnutrition in children under-5 years was lesser in the high coverage group than in the low one; however relative changes were not statistically significant.</p> <p>Conclusions</p> <p>Despite the adverse contextual conditions and the limitations imposed by the Colombian health system itself, Bogota’s initiative of a PHC strategy has successfully contributed to the improvement of some health outcomes.</p> |
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| format | Article |
| id | doaj.art-f790821467f445ca8f75dea016fe3af3 |
| institution | Directory Open Access Journal |
| issn | 1471-2296 |
| language | English |
| last_indexed | 2024-04-13T12:23:51Z |
| publishDate | 2012-08-01 |
| publisher | BMC |
| record_format | Article |
| series | BMC Family Practice |
| spelling | doaj.art-f790821467f445ca8f75dea016fe3af32022-12-22T02:47:05ZengBMCBMC Family Practice1471-22962012-08-011318410.1186/1471-2296-13-84Primary health care contribution to improve health outcomes in Bogota-Colombia: a longitudinal ecological analysisMosquera Paola AHernández JinnethVega RománMartínez JorgeLabonte RonaldSanders DavidSebastián Miguel<p>Abstract</p> <p>Background</p> <p>Colombia has a highly segmented and fragmented national health system that contributes to inequitable health outcomes. In 2004 the district government of Bogota initiated a Primary Health Care (PHC) strategy to improve health care access and population health status. This study aims to analyse the contribution of the PHC strategy to the improvement of health outcomes controlling for socioeconomic variables.</p> <p>Methods</p> <p>A longitudinal ecological analysis using data from secondary sources was carried out. The analysis used data from 2003 and 2007 (one year before and 3 years after the PHC implementation). A Primary Health Care Index (PHCI) of coverage intensity was constructed. According to the PHCI, localities were classified into two groups: high and low coverage. A multivariate analysis using a Poisson regression model for each year separately and a Panel Poisson regression model to assess changes between the groups over the years was developed. Dependent variables were infant mortality rate, under-5 mortality rate, infant mortality rate due to acute diarrheal disease and pneumonia, prevalence of acute malnutrition, vaccination coverage for diphtheria, pertussis, tetanus (DPT) and prevalence of exclusive breastfeeding. The independent variable was the PHCI. Control variables were sewerage coverage, health system insurance coverage and quality of life index.</p> <p>Results</p> <p>The high PHCI localities as compared with the low PHCI localities showed significant risk reductions of under-5 mortality (13.8%) and infant mortality due to pneumonia (37.5%) between 2003 and 2007. The probability of being vaccinated for DPT also showed a significant increase of 4.9%. The risk of infant mortality and of acute malnutrition in children under-5 years was lesser in the high coverage group than in the low one; however relative changes were not statistically significant.</p> <p>Conclusions</p> <p>Despite the adverse contextual conditions and the limitations imposed by the Colombian health system itself, Bogota’s initiative of a PHC strategy has successfully contributed to the improvement of some health outcomes.</p>http://www.biomedcentral.com/1471-2296/13/84Primary health careHealth outcomesPopulation HealthOutcomes AssessmentMultivariate analysisBogota |
| spellingShingle | Mosquera Paola A Hernández Jinneth Vega Román Martínez Jorge Labonte Ronald Sanders David Sebastián Miguel Primary health care contribution to improve health outcomes in Bogota-Colombia: a longitudinal ecological analysis BMC Family Practice Primary health care Health outcomes Population Health Outcomes Assessment Multivariate analysis Bogota |
| title | Primary health care contribution to improve health outcomes in Bogota-Colombia: a longitudinal ecological analysis |
| title_full | Primary health care contribution to improve health outcomes in Bogota-Colombia: a longitudinal ecological analysis |
| title_fullStr | Primary health care contribution to improve health outcomes in Bogota-Colombia: a longitudinal ecological analysis |
| title_full_unstemmed | Primary health care contribution to improve health outcomes in Bogota-Colombia: a longitudinal ecological analysis |
| title_short | Primary health care contribution to improve health outcomes in Bogota-Colombia: a longitudinal ecological analysis |
| title_sort | primary health care contribution to improve health outcomes in bogota colombia a longitudinal ecological analysis |
| topic | Primary health care Health outcomes Population Health Outcomes Assessment Multivariate analysis Bogota |
| url | http://www.biomedcentral.com/1471-2296/13/84 |
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