List of potentially avoidable causes of death in childhood: a proposal for 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.