Prospective study of malaria in pregnancy, placental and congenital malaria in Northwest Colombia.

BACKGROUND: Pregnancy Associated Malaria (PAM) include malaria in pregnancy (MiP), placental malaria (PM), and congenital malaria (CM). The evidence available in Colombia on PAM focuses on one of the presentations (MiP, PM or CM), and no study longitudinally analyses the infection from the pregnant woman, passing through the placenta, until culminating in the newborn. This study determined the frequency of MiP, PM, and CM caused by Plasmodium vivax, Plasmodium falciparum, or mixed infections, according to Thick Blood Smear (TBS) and quantitative Polymerase Chain Reaction (qPCR). Identifying associated factors of PAM and clinical-epidemiological outcomes in northwestern Colombia. METHODS: Prospective study of 431 pregnant women, their placenta, and newborns registered in the data bank of the research Group "Salud y Comunidad César Uribe Piedrahíta" which collected information between 2014 and 2020 in endemic municipalities of the departments of Córdoba and Antioquia. The frequency of infection was determined with 95% confidence intervals. Comparisons were made with the Chi-square test, Student t-test, prevalence ratios, and control for confounding variables by log-binomial regression. RESULTS: The frequency of MiP was 22.3% (4.6% using TBS), PM 24.8% (1.4% using TBS), and CM 11.8% (0% using TBS). Using TBS predominated P. vivax. Using qPCR the proportions of P. vivax and P. falciparum were similar for MiP and PM, but P. falciparum predominated in CM. The frequency was higher in nulliparous, and women with previous malaria. The main clinical effects of PAM were anaemia, low birth weight, and abnormal APGAR score. CONCLUSIONS: The magnitude of infections was not detected with TBS because most cases were submicroscopic (TBS-negative, qPCR-positive). This confirmed the importance of improving the molecular detection of cases. PAM continue being underestimated in the country due to that in Colombia the control programme is based on TBS, despite its outcomes on maternal, and congenital health.

Lifestyles associated with malaria in pregnancy in northwest Colombia: a mixed study from Latin American critical epidemiology.

BACKGROUND: In the scientific literature on Malaria in Pregnancy (MiP), no studies have been conducted on lifestyles based on critical theory. The objective of this study was to analyse the lifestyles or singular processes of social determination of health in MiP in northwestern Colombia. METHODS: Mixed QUAN-QUAL convergent triangulation study. In the quantitative component, a psychometric evaluation and a cross-sectional design were conducted in 400 pregnant women to whom the Pender-Walker lifestyle scale and a survey on MiP prevention were applied. In the qualitative study, a critical ethnography was conducted with 46 pregnant women in whom their narratives and practices regarding lifestyles at home and healthcare were described. RESULTS: The frequency of MiP was 9%, and a higher occurrence of the disease was identified in those who did not control stagnant water (29%), did not use insecticide-treated net (16%) and went to the hospital (14%) or the microscopist (20%) when they had fever. This coincides with the presence of unhealthy lifestyles, little knowledge about malaria, and a low perception of the risk of getting sick, as well as meanings and experiences about MiP, maternity, and pregnancy that show a high clinical, cultural, and socioeconomic burden for the women studied. CONCLUSION: This epidemiological profile and the approach to lifestyles based on the postulates of critical theory in health evidence that pregnant women exposed to malaria suffer serious social, cultural and health injustices that are not possible to impact with the current health model of malaria control in Colombia guided by aetiopathogenic, biomedical, positivist and utilitarian theories.

Social determination of malaria in pregnancy in Colombia: a critical ethnographic study.

BACKGROUND: The meanings and experiences related to malaria in pregnancy (MiP) and its processes of social determination of health (PSDH) have not been reported in the world scientific literature. The objective was to understand the meanings and experiences of MiP, and to explain their PSDH in an endemic area from Colombia, 2022. METHODS: Critical ethnography with 46 pregnant women and 31 healthcare workers. In-depth and semi-structured interviews, focus group discussions, participant and non-participant observations, and field diaries were applied. A phenomenological-hermeneutic analysis, saturation and triangulation was carried out. The methodological rigor criteria were reflexivity, credibility, auditability, and transferability. RESULTS: At the singular level, participants indicated different problems in antenatal care and malaria control programmes, pregnant women were lacking knowledge about MiP, and malaria care was restricted to cases with high obstetric risk. Three additional levels that explain the PSDH of MiP were identified: (i) limitations of malaria control policies, and health-system, geographic, cultural and economic barriers by MiP diagnosis and treatment; (ii) problems of public health programmes and antenatal care; (iii) structural problems such as monetary poverty, scarcity of resources for public health and inefficiency in their use, lacking community commitment to preventive actions, and breach of institutional responsibilities of health promoter entity, municipalities and health services provider institutions. CONCLUSION: Initiatives for MiP control are concentrated at the singular level, PDSH identified in this research show the need to broaden the field of action, increase health resources, and improve public health programmes and antenatal care. It is also necessary to impact the reciprocal relationships of MiP with economic and cultural dimensions, although these aspects are increasingly diminished with the predominance and naturalization of neoliberal logic in health.

A systematic review of mixed studies on malaria in Colombia 1980-2022: what the "bifocal vision" discovers.

Mixed methods are essential in public health research and malaria control, because they allow grasping part of the complexity and diversity of the factors that determine health-disease. This study analyzes the mixed studies on malaria in Colombia, 1980-2022, through a systematic review in 15 databases and institutional repositories. The methodological quality was assessed with Mixed Methods Appraisal Tool (MMAT), STrengthening the Reporting of OBservational studies in Epidemiology (STROBE), and Standards for Reporting Qualitative Research (SRQR). The qualitative and quantitative findings were grouped into a four-level hierarchical matrix. The epidemiological profile of malaria morbidity, from traditional epidemiology, has been sustained by environmental problems, armed conflict, individual risk behaviors, and low adherence to recommendations from health institutions. However, the qualitative component reveals deeper causes that are less studied, of greater theoretical complexity, and that reflect challenges to design and implement health interventions, such as socioeconomic and political crises, poverty, and the neoliberal orientation in the malaria control policy; the latter reflected in the change in the role of the State, the fragmentation of control actions, the predominance of insurance over social assistance, the privatization of the provision of health services, the individualistic and economistic predominance of health, and low connection with popular tradition and community initiatives. The above confirms the importance of expanding mixed studies as a source of evidence to improve malaria research and control models in Colombia, and to identify the underlying causes of the epidemiological profile.

Interaction of histological events and physiological mediators in healthy placentas from malaria-endemic area in Colombia: An approach with a factorial model.

The biological study of the placenta is fragmented and focused on morbid events. The interaction of histological events and mediators of physiological processes in healthy placentas in malaria-endemic areas is unknown. This study aimed to build a factorial model for the convergence of events and mediators in healthy placentas of women living in northwestern Colombia through a study of 44 placentas. Linear correlations and exploratory factor analysis were carried out with histological events and expression of genes related to mediators. The factor analysis allowed us the identification of three components. The first compound by the following histological variables: number of capillaries and villus, immune cells in villus, atherosis, and CD8+ lymphocytes. The second with articulation of histological variables (syncytyal nodes, fibrinoid deposits, thrombi and immune cells) and physiological mediators of apoptosis and regulation. The thirth included physiological mediators of hypoxia, angiogenesis, pro-inflammation and anti-inflammation. All components presented excellent predictive and construct validity, and excellent goodness of fit parameters. In healthy placentas, the factorial structure of histological events and physiological mediators in three underlying components that support their interactions was demonstrated. These findings are significant because they help improve the study of healthy placental biology in malaria endemic areas and evaluate mechanisms that alter its morphology and function, with their subsequent risk for pregnancy and maternal-fetal health.

Cost-effectiveness of rapid diagnostic tests, compared to microscopic tests, for the diagnosis and treatment of gestational malaria in Colombia from an institutional perspective.

BACKGROUND: Gestational malaria is associated with negative outcomes in maternal and gestational health; timely diagnosis is crucial to avoid complications. However, the limited infrastructure, equipment, test reagents, and trained staff make it difficult to use thick blood smear tests in rural areas, where rapid testing could be a viable alternative. The purpose of this study was to estimate the cost-effectiveness of rapid tests type III (Plasmodium falciparum/Plasmodium spp P.f/pan) versus microscopic tests for the diagnosis and treatment of gestational malaria in Colombia. METHODS: Cost-effectiveness analyses of gestational malaria diagnosis from an institutional perspective using a decision tree. Standard costing was performed for the identification, measurement and assessment phases, with data from Colombian tariff manuals. The data was collected from Health Situation Analysis, SIVIGILA and meta-analysis. Average and incremental cost-effectiveness ratio were estimated. The uncertainty was assessed through probabilistic sensitivity analysis. RESULTS: The cost of rapid diagnostic tests in 3,000 pregnant women with malaria was US$66,936 and 1,182 disability adjusted life years (DALYs) were estimated. The cost using thick blood smear tests was US$50,838 and 1,023 DALYs, for an incremental cost-effectiveness of US$ 101.2. The probabilistic sensitivity analysis of rapid diagnostic tests determined that they are highly cost-effective in 70% of the cases, even below the US$1,200 threshold; also, they showed an incremental net monetary benefit of $150,000 when payer's willingness is US$1,000. CONCLUSION: The use of rapid diagnostic tests for timely diagnosis and treatment of gestational malaria is a highly cost-effective strategy in Colombia, with uncertainty analyses supporting the robustness of this conclusion and the increased net monetary benefit that the health system would obtain. This strategy may help in preventing the negative effects on maternal health and the neonate at a low cost.

Systematization of analytical studies of polycythemia vera, essential thrombocythemia and primary myelofibrosis, and a meta-analysis of the frequency of JAK2, CALR and MPL mutations: 2000-2018.

BACKGROUND: Research into Philadelphia-negative chronic myeloproliferative neoplasms is heterogeneous. In addition, no systematization of studies of polycythemia vera (PV), essential thrombocythemia (ET) or primary myelofibrosis (PMF) have been carried out. The objective of this review is to characterize studies on BCR-ABL1-negative chronic myeloproliferative neoplasms and to compare the frequency of JAK2, MPL and CALR mutations in PV, ET and PMF. METHOD: A systematic review of the scientific literature was conducted, as was meta-analysis with an ex-ante selection of protocol, according to phases of the PRISMA guide in three interdisciplinary databases. To guarantee reproducibility in the pursuit and retrieval of information, the reproducibility and methodological quality of the studies were evaluated by two researchers. RESULTS: Fifty-two studies were included, the majority having been carried out in the United States, China, Brazil and Europe. The frequency of the JAK2V617F mutation ranged from 46.7 to 100% in patients with PV, from 31.3 to 72.1% in patients with ET, and from 25.0 to 85.7% in those with PMF. The frequency of the MPL mutation was 0% in PV, from 0.9 to 12.5% in ET, and from 0 to 17.1% in PMF. The CALR mutation occurred at a frequency of 0.0% in PV, whereas in ET, it ranged from 12.6 to 50%, and in PMF, it ranged from 10 to 100%. The risk of this mutation presenting in PV is 3.0 times that found for ET and 4.0 times that found for PMF. CONCLUSION: Given the specificity and reported high frequencies of the JAK2V617F, MPL and CALR mutations in this group of neoplasms, the diagnosis of these diseases should not be made on clinical and hematological characteristics alone but should include genetic screening of patients.

[Social determination and determinants of malaria: a systematic review, 1980-2018Determinação social e determinantes sociais da malária: revisão sistemática, 1980-2018]. / Determinación y determinantes sociales de la malaria: revisión sistemática, 1980-2018.

OBJECTIVE: Describe how the 'social determination of health' approach has been applied in malaria studies around the world. METHODS: Systematic review of original studies published from 1980 to 2018. Six search strategies were used in ten multidisciplinary databases, and in libraries and repositories of seven universities in Brazil, Colombia, Ecuador, and Peru. PRISMA guidelines were followed, methodological quality was evaluated according to STROBE criteria, and a qualitative summary of the results was conducted. RESULTS: Ten studies published from 1984 to 2017 met pre-established inclusion and exclusion criteria; 33 social determinants of malaria were identified. Of individual determinants, greater malaria risk was found in adults, people who are often outdoors at night, and people who do not take preventive measures; intermediate determinants were dwellings with poor physical and sanitary infrastructure, overcrowded, located in forested areas, and containing animals. Regarding socioeconomic determinants, the people at greatest risk were involved in agro-forestry activities, migrants, and those with low income and a low educational level. Malaria caused high economic losses and led to poverty and educational delay. CONCLUSION: No studies were found that used Latin American social medicine approaches or that applied the World Health Organization's hierarchical and multilevel analysis for individual, intermediate, and structural determinants. No progress has been made in the analysis of social categories-territory, social class, gender, ethnic group, macroeconomic policies-or other socioeconomic characteristics that determine risk of illness or death from malaria.

OBJETIVO: Descrever como foi aplicado o enfoque da determinação social da saúde nos estudos de malária no mundo. MÉTODOS: Uma revisão sistemática de estudos originais publicados entre 1980 e 2018 foi conduzida com o uso de seis estratégias de busca em 10 bases de dados multidisciplinares e em bibliotecas e repositórios de sete universidades do Brasil, Colômbia, Equador e Peru. O estudo se baseou nos critérios da recomendação PRISMA e a qualidade metodológica foi avaliada segundo os critérios da iniciativa STROBE. Foi realizada uma síntese qualitativa dos resultados. RESULTADOS: Dez estudos publicados entre 1984 e 2017 preencheram os critérios de inclusão e exclusão predefinidos. Foram identificados 33 determinantes sociais da malária. Com relação aos determinantes individuais, foi observado maior risco da malária em adultos, pessoas com hábitos noturnos e que não aderem a práticas preventivas. Os determinantes intermediários foram moradias com infraestruturas física e sanitária precárias, com aglomeração de pessoas, localizadas em áreas de mata e com a presença de animais. E, quanto aos determinantes socioeconômicos, houve maior risco da doença entre os indivíduos que se dedicam a atividades agroflorestais, migrantes e pessoas com baixa escolaridade e baixa renda. A malária causou grande prejuízo econômico, gerando pobreza e atraso educacional. CONCLUSÃO: Não foram encontrados estudos com enfoques da medicina social latino-americana nem estudos contendo análises com modelo hierárquico e multinível para os determinantes individuais, intermediários e estruturais de acordo com a definição da Organização Mundial da Saúde. Não foi possível aprofundar a análise das categorias sociais (território, classe social, gênero, etnia e políticas macroeconômicas) ou outras características socioeconômicas que determinam o risco de ter a doença ou morrer de malária.

Comprehensive economic evaluation of thermotherapy for the treatment of cutaneous leishmaniasis in Colombia.

BACKGROUND: Cutaneous leishmaniasis causes a high disease burden in Colombia, and available treatments present systemic toxicity, low patient compliance, contraindications, and high costs. The purpose of this study was to estimate the cost-effectiveness of thermotherapy versus Glucantime in patients with cutaneous leishmaniasis in Colombia. METHODS: Cost-effectiveness study from an institutional perspective in 8133 incident cases. Data on therapeutic efficacy and safety were included, calculating standard costs; the outcomes were disability adjusted life years (DALYs) and the number of patients cured. The information sources were the Colombian Public Health Surveillance System, disease burden studies, and one meta-analysis of controlled clinical trials. Incremental cost-effectiveness was determined, and uncertainty was evaluated with tornado diagrams and Monte Carlo simulations. RESULTS: Thermotherapy would generate costs of US$ 501,621; the handling of adverse effects, US$ 29,224; and therapeutic failures, US$ 300,053. For Glucantime, these costs would be US$ 2,731,276, US$ 58,254, and US$ 406,298, respectively. With thermotherapy, the cost would be US$ 2062 per DALY averted and US$ 69 per patient cured; with Glucantime, the cost would be US$ 4241 per DALY averted and US$ 85 per patient cured. In Monte Carlo simulations, thermotherapy was the dominant strategy for DALYs averted in 67.9% of cases and highly cost-effective for patients cured in 72%. CONCLUSION: In Colombia, thermotherapy can be included as a cost-effective strategy for the management of cutaneous leishmaniasis. Its incorporation into clinical practice guidelines could represent savings of approximately US$ 10,488 per DALY averted and costs of US$ 116 per additional patient cured, compared to the use of Glucantime. These findings show the relevance of the incorporation of this treatment in our country and others with similar parasitological, clinical, and epidemiological patterns.

[Social determinants of intestinal parasitism, malnutrition, and anemia: systematic review]. / Determinantes sociales del parasitismo intestinal, la desnutrición y la anemia: revisión sistemática.

OBJECTIVE: Characterize the publications on social determinants of intestinal parasitism, malnutrition, and anemia at the global level. METHODS: A systematic review was conducted of the scientific literature in Pubmed, Science Direct, SciELO, LILACS, and Google Scholar with eight search strategies, guaranteeing completeness and replicability, following the phases of the PRISMA guidelines. RESULTS: The review included 18 studies on malnutrition, three on parasitism, three on anemia, and two on both parasitism and malnutrition; 65.4% of the studies were from South America and 69.2% were carried out among children. The prevalence of intestinal parasitism ranged between 30.6% and 83.3%; anemia, 19.7% to 48.0%; and malnutrition, 0.0% to 67.8%. It was found that biological and psychosocial determinants were most frequently studied; the most frequently studied intermediate determinants were related to housing and income; and structural determinants were least investigated. The social determinants common to the three conditions include: living in homes with poor sanitary conditions, rural areas, inadequate housing, inadequate water supply, access barriers to the medical system, young parents with little schooling, precarious employment, and low income. CONCLUSION: The majority of publications do not conduct a multilevel analysis for individual, intermediate, or structural determinants. Greater efforts are needed in health policies that address the social determinants of inequality with respect to parasitism, malnutrition, and anemia, mainly in categories as macroeconomic policy, social class, labor market, culture, values, and territory.

Meta-analysis of the utility of culture, biopsy, and direct KOH examination for the diagnosis of onychomycosis.

BACKGROUND: Onychomycosis is a highly prevalent disease worldwide. There is no standard test for its diagnosis, which remains costly, wasteful, and is sometimes delayed. The diagnostic tests for this disease are few and discordant. The objective was to evaluate the diagnostic validity, performance, and accuracy of culture, nail clipping with Periodic Acid-Schiff -PAS- staining (biopsy), and direct potassium hydroxide (KOH) examination for the study of onychomycosis. METHODS: A systematic review was conducted via meta-analysis using 5 databases and 21 search strategies. An ex ante protocol was applied with inclusion and exclusion criteria. Quality was assessed with the Quality Assessment of Diagnostic Accuracy Studies (QUADAS) tool, and the sensitivity, specificity, predictive values, likelihood ratios, diagnostic odds ratios, receiver operating characteristic (ROC) curves, and proportion of correctly diagnosed patients were evaluated with the meta-analysis of studies of evaluations of diagnostic and screening tests (Meta-DiSc) and Epidat using a random effects model. RESULTS: The efficiency or accuracy of the three tests is influenced by the methodological quality of the studies. These values are lower for KOH and culture and higher for biopsy in moderate quality studies. CONCLUSION: The diagnostic tests evaluated in this meta-analysis independently showed acceptable validity, performance, and efficiency, with nail clipping with PAS staining outperforming the other two tests.

[Meta-analysis of the usefulness of ELISA, PCR, and immunochromatography for the diagnosis of ChikungunyaMeta-análise da utilidade dos exames ELISA, PCR e imunocromatografia no diagnóstico de febre chikungunya]. / Metanálisis sobre la utilidad de ELISA, PCR e inmunocromatografía en el diagnóstico de chikungunya.

OBJECTIVE: Evaluate the usefulness of ELISA, PCR, and immunochromatography for the diagnosis of Chikungunya. METHODS: A meta-analysis of studies reporting diagnostic validity data was performed, using an ex-ante protocol with six search strategies in three multidisciplinary databases. Replicability in the selection and retrieval of information was guaranteed; quality was evaluated using the QUADAS (Quality Assessment of Diagnostic Accuracy Studies) guide; the analyses were performed in MetaDisc, with specific measures, confidence intervals, and combined results under a random-effects model. RESULTS: A total of 19 studies were included, one with IgG ELISA, two with antigencapture ELISA, five with IgM ELISA, eight with qPCR, and three with immunochromatography. The articles were published primarily in India (37%) between 2009 and 2015, using a combination of clinical symptoms, RT-PCR, ELISA, neutralization assay, or viral isolation as the reference test. The population consisted of 1 108 healthy individuals, 394 with another infection (mainly dengue), and 1 288 with Chikungunya. In IgM ELISA and qPCR, the sensitivity and specificity were greater than 90%, the positive probability quotient was greater than 10, the negative probability quotient was less than 0.1, the diagnostic odds ratio was greater than 100, and the area under the curve was 0.99.

OBJETIVO: Avaliar a utilidade dos exames ELISA, PCR e imunocromatografia no diagnóstico de febre chikungunya. MÉTODOS: Uma meta-análise de estudos com dados de validade diagnóstica foi conduzida em três bases de dados multidisciplinares segundo um protocolo de avaliação ex-ante contendo seis estratégias de busca. Foi garantida a reprodutibilidade na seleção e extração de informação e avaliada a qualidade segundo os critérios do guia QUADAS (Quality Assessment of Studies of Diagnostic Accuracy). As análises foram realizadas no programa Meta-DiSc com estimativas pontuais, intervalos de confiança e resultados combinados em um modelo de efeitos aleatórios. RESULTADOS: A meta-análise incluiu 19 estudos, a saber: um sobre ELISA de anticorpos IgG, dois sobre ELISA de antígenos, cinco sobre ELISA de anticorpos IgM, oito sobre PCR quantitativa (qPCR) e três sobre imunocromatografia. Os artigos foram publicados entre 2009 e 2015, sobretudo na Índia (37%), e usaram como referência critérios clínicos, PCR em tempo real (RT-PCR), ELISA, ensaio de neutralização ou isolamento viral. A população abrangeu 1.108 indivíduos saudáveis, 394 que apresentavam outra infecção (mais comumente, dengue) e 1.288 com febre chikungunya. Com relação ao ELISA-IgM e qPCR, a sensibilidade e a especificidade foram superiores a 90%, a razão de probabilidade positiva foi maior que 10 e a razão de probabilidade negativa menor que 0,1, a razão de chances diagnóstica foi maior que 100 e a área sob a curva foi de 0,99. CONCLUSÃO: Verificou-se excelente utilidade diagnóstica do ELISA-IgM e qPCR e baixa utilidade da imunocromatografia no diagnóstico de febre chikungunya.

Efficacy of cryotherapy for the treatment of cutaneous leishmaniasis: meta-analyses of clinical trials.

BACKGROUND: Cryotherapy is a local treatment for cutaneous leishmaniasis with variable efficacy and greater safety than conventional treatment. The objective of this study is to evaluate the efficacy and safety of cryotherapy for the treatment of cutaneous leishmaniasis and to compare it with pentavalent antimonials. METHODS: A meta-analysis based on a search of nine databases with eight strategies was conducted. Inclusion and exclusion criteria were applied, the methodological quality of each article was evaluated, and the reproducibility of the study selection and information extraction from each clinical trial was assured. The per lesion and per patient efficacy was calculated, and a meta-analysis of relative risks with the random effects model and the Dersimonian and Laird's, Begg, and Egger tests, along with a sensitivity analysis, were performed. A meta-regression based on the methodological quality of the trials included was also performed. RESULTS: Eight studies were included in which respective per lesion efficacies of 67.3 % and 67.7 % were reported for cryotherapy and pentavalent antimonials. In 271 patients treated with cryotherapy and in 199 with pentavalent antimonials, respective per protocol and intent to treat efficacies of 63.6 % and 54.2 % were found in the first group, and per protocol and intent to treat efficacies of 74.7 % and 68.3 % were found in the second group. The relative risk for the comparison of efficacy in the two groups was 0.73 (0.42-1.29). The results of the sensitivity analysis and the meta-regression analysis of relative risks were statistically equal to the overall results. CONCLUSION: This investigation provides evidence in favor of the use of cryotherapy given that its efficacy is similar to that of pentavalent antimonials.

Prevalence of HIV, Treponema pallidum and Their Coinfection in Men Who Have Sex with Men, Medellín-Colombia.

Introduction: In Colombia, HIV and gestational syphilis are notifiable events; however, they are poorly investigated infections in men who have sex with men (MSM). Objective: To determine the prevalence of HIV, Treponema pallidum, and their co-infection in MSM treated at a Health Services Provider Institution (HSPI) specialized in infectious diseases from Medellín. Methods: Cross-sectional study with 3454 MSM. Prevalence was determined with its 95% confidence interval; associated factors were identified using Fisher's Exact test, Pearson's Chi-square, and trend Chi-square. Multivariate adjustment was performed using logistic regression. Analyses were performed using SPSS 29.0. Results: The prevalence of HIV was 5.7%, T. pallidum 0.7%, and co-infection 0.6%. The prevalence of HIV was higher in MSM aged between 24-40 years (7.5%), with technical or university studies (10.0%), without health insurance affiliation (12.4%), and those who have had a sexual partner with HIV (36.2%). T. pallidum was higher in MSM without health insurance affiliation (3.4%), who had sexual relations with people diagnosed with an STI (5.9%), and a sexual partner with HIV (12.1%). Co-infection was higher in MSM without health insurance affiliation (2.7%), and those who had a partner with HIV (11.2%). Conclusion: Compared with the general Colombian population, MSM have a higher risk of HIV, but are similar to T. pallidum. The identification of the main associated factors in each infection demonstrates the need to prioritize subgroups of MSM that show greater vulnerability to these events. This research demonstrates the urgency of implementing health education strategies in MSM who have a sexual partner with HIV or other STIs. Large gaps were also evident in the magnitude of the three events according to the health insurance affiliation regime, which demonstrates problems of social and health injustice, especially with MSM without health insurance affiliation.

Synthesis of Qualitative Evidence on Malaria in Pregnancy, 2005-2022: A Systematic Review.

Qualitative research on malaria in pregnancy (MiP) is incipient, therefore its contextual, experiential and symbolic associated factors are unknown. This study systematizes the qualitative research on MiP, describes knowledge, perceptions and behaviors about MiP, and compiles individual, socioeconomic, cultural and health system determinants of MiP through a meta-synthesis in 10 databases. A total of 48 studies were included with 2600 pregnant women, 1300 healthcare workers, and 2200 relatives or community members. Extensive knowledge was demonstrated on ITN and case management, but it was lacking on SP-IPTp, risks and consequences of MiP. Attitudes were negative towards ANC and MiP prevention. There were high trustfulness scores and preference for traditional medicine and distrust in the safety of drugs. The main determinants of the Health System were rationing, copayments, delay in payment to clinics, high out-of-pocket expenses, shortage, low workforce and work overload, shortcomings in care quality, low knowledges of healthcare workers on MiP and negative attitude in care. The socioeconomic and cultural determinants were poverty and low educational level of pregnant women, distance to the hospital, patriarchal-sexist gender roles, and predominance of local conceptions on maternal-fetal-neonatal health. The meta-synthesis demonstrates the difficulty to detect MiP determinants and the importance of performed qualitative research before implementing MiP strategies to understand the multidimensionality of the disease.

Impact of COVID-19 Pandemic on Seroprevalence of HIV, HBV, HCV and HTLV I-II in a Blood Bank in Medellín, Colombia, 2019-2022.

The objective of this research was to analyze the impact of the COVID-19 pandemic on seroprevalence of HIV, HBV, HCV and HTLV I-II in donors from a blood bank in Medellin, Colombia, 2019-2022. A cross-sectional analytical study was carried out with three groups: pre-pandemic with 14,879 donors; preventive isolation with 9035; and selective isolation + new normality with 26,647 subjects. Comparisons were made with Chi2 and Bonferroni adjustment, Kruskal-Wallis' H with Dunnett's post-hoc, prevalence ratios, and multivariate logistic regression. COVID-19 decreased donations of men, altruistic and repetitive donors, and increased the age of donors. HIV increased with the COVID-19 pandemic, while HBV, HCV, and HTLV I-II decreased. The pandemic had an independent effect on these viral infections. These findings constitute an alert about what may be happening in the general population and show the importance of improving epidemiological surveillance and the investigation of these infections.

Diagnostic Accuracy of a Thick Blood Smear Compared to qPCR for Malaria Associated with Pregnancy in Colombia.

This study aimed to evaluate the accuracy of the thick blood smear (TBS) versus quantitative polymerase chain reaction (qPCR) for the diagnosis of malaria associated with pregnancy (MAP) caused by P. falciparum or P. vivax in Colombia in its gestational malaria (GM), placental malaria (PM), and congenital malaria (CM) forms as well as to compare its accuracy in different subgroups of pregnant women according to the presence of fever, anemia and a history of malaria. This was a diagnostic evaluation of 829 pregnant women, 579 placentas, 381 umbilical cord samples, and 221 neonatal peripheral blood samples. Accuracy was evaluated based on the parameters of sensitivity, specificity, predictive values, likelihood ratios, and validity index, with their 95% confidence intervals. The frequency of GM was 36% (n = 297/829), PM 27% (n = 159/579), and CM 16.5% (n = 63/381) in umbilical cord samples and 2% (n = 5/221) in neonatal peripheral blood samples. For GM, the sensitivity was 55%, with higher rates in those infected with P. vivax (68%), with a history of malaria (69%), and with fever (96%). These three subgroups presented the best results in terms of the negative likelihood ratio and validity index. For PM, sensitivity was 8%; in subgroup analyses in terms of species, symptomatology (anemia and fever), and history of malaria, it was 1-18%, and the negative likelihood ratio was >0.80 in all subgroups. No false positives were recorded in any of the subgroups. The TBS did not detect any cases of CM. This study found the TBS yielded satisfactory results in terms of diagnosing GM for P. vivax, pregnant women with previous malaria and febrile. It also showed that the TBS is not useful for diagnosing PM and CM. It is necessary to conduct surveillance of MAP with molecular methods in in groups where TBS is deficient (asymptomatic GM, P. falciparum, and pregnant women without history of malaria) to optimize the timely treatment of PM and CM, avoid the deleterious effects of MAP and achieve the malaria elimination goals in Colombia.

Explanatory Model of Psychogenic, Behavioral and Environmental Causal Attributions of Cancer, and Their Psychogenic, Biomedical and Alternative Treatment in the General Population of Medellín, Colombia.

BACKGROUND: Understanding the causal attributions for cancer, the elements affecting therapeutic adherence, and behaviors that may compromise people's health or even put them at risk of dying from this disease has garnered a considerable degree of attention. METHODS: This study was designed in the city of Medellín with the aim to develop and validate a model for the study of (i) the categories that can be attributable to cancer etiology, (ii) the categories that can be attributed to the efficacy of treatment, and (iii) the relationship between the categories that can be attributed to the etiology and to the efficacy of the treatment. Structural equations were performed on 611 participants. RESULTS: The analysis revealed that attributing the disease to psychogenic factors distances people from biomedical treatments (ß coefficient, -0.12), and brings them closer to psychogenic (ß coefficient, 0.22) and alternative treatments (ß coefficient, 0.24). Attributing cancer to behavioral factors brings people closer to psychogenic treatments (ß coefficient, 0.40) over biomedical treatments (ß coefficient, 0.24). CONCLUSIONS: Symbolic, cultural, and social factors were evidenced, thereby leading to the underestimation of biomedical treatments and imparting a greater degree of importance to psychogenic or alternative therapies. These therapies will subsequently affect the achievement of therapeutic objectives such as increased survival.

Clinical and Parasitological Profiles of Gestational, Placental and Congenital Malaria in Northwestern Colombia.

This study compared the clinical-parasitological profiles of gestational (GM), placental (PM), and congenital (CM) malaria in northwestern Colombia. A cross-sectional study with 829 pregnant women, 549 placentas, and 547 newborns was conducted. The frequency of GM was 35.8%, PM 20.9%, and CM 8.5%. P. vivax predominated in GM; in PM, the proportion of P. vivax and P. falciparum was similar; in CM, P. falciparum predominated. The main clinical findings were headache (49%), anemia (32%), fever (24%), and musculoskeletal pain (13%). The clinical manifestations were statistically higher in P. vivax infections. In submicroscopic GM (positive with qPCR and negative with thick blood smear), the frequency of anemia, sore throat, and a headache was statistically higher compared with pregnant women without malaria. GM, PM, and CM reduce birth weight and head circumference. In Colombia, this is the first research on the clinical characteristics of GM, PM, and CM; contrary to evidence from other countries, P. vivax and submicroscopic infections are associated with clinical outcomes.