Genes and Pathways Involved in the Progression of Malignant Pleural Mesothelioma: A Meta-analysis of Genome-Wide Expression Studies.

Malignant pleural mesothelioma (MPM) is a rare and aggressive neoplasm of the pleural tissue that lines the lungs and is mainly associated with long latency from asbestos exposure. This tumor has no effective therapeutic opportunities nowadays and has a very low five-year survival rate. In this sense, identifying molecular events that trigger the development and progression of this tumor is highly important to establish new and potentially effective treatments. We conducted a meta-analysis of genome-wide expression studies publicly available at the Gene Expression Omnibus (GEO) and ArrayExpress databases. The differentially expressed genes (DEGs) were identified, and we performed functional enrichment analysis and protein-protein interaction networks (PPINs) to gain insight into the biological mechanisms underlying these genes. Additionally, we constructed survival prediction models for selected DEGs and predicted the minimum drug inhibition concentration of anticancer drugs for MPM. In total, 115 MPM tumor transcriptomes and 26 pleural tissue controls were analyzed. We identified 1046 upregulated DEGs in the MPM samples. Cellular signaling categories in tumor samples were associated with the TNF, PI3K-Akt, and AMPK pathways. The inflammatory response, regulation of cell migration, and regulation of angiogenesis were overrepresented biological processes. Expression of SOX17 and TACC1 were associated with reduced survival rates. This meta-analysis identified a list of DEGs in MPM tumors, cancer-related signaling pathways, and biological processes that were overrepresented in MPM samples. Some therapeutic targets to treat MPM are suggested, and the prognostic potential of key genes is shown.

Effect of Sample Sources on Heavy Metal Concentration Measured in Beta Vulgaris Organs.

Aim: Heavy metal concentration [mg/dL, MP] in soil and the transfer to vegetable organs may have a sampling effect. We compared the [MP] in soil and organ samples of Beta vulgaris collected in sites with socioeconomic differences potentially inducing phytotoxicity. Materials and Methods: Samples of Beta vulgaris and soils (n = 4 per sample of soil and plant material) were randomly collected from two distant geographic areas (Mosquera and Sibaté, Cundinamarca, Colombia). We determined the [MP] using acid digestion of HCl : HNO3 [1 : 1]; the [MP] was obtained by atomic absorption in Varian AA-140 and Shimadzu AA-7000 equipment. A two-way ANOVA estimated the effect (partial η2) of the sampling site and metal type on the [MP] and transfer to the vegetable. Results: In Sibaté, the means (SD) of As_1.44 (0.18), Co_1.09 (0.51), Cr_6.21 (0.33), Ni_0.22 (0.02), and Pb_4.17 (0.87) were higher than in Mosquera (As_1.06 (0.21), Co_0.81 (0.19), Cr_3.72 (0.51), Ni_0.13 (0.04), and Pb_1.69 (0.40)) (p value <0.05). The effect of the interaction between the metal type and Beta vulgaris organs on the [MP] (0.801) in Sibaté was more meaningful than in Mosquera (0.430). Additionally, there was a strong correlation (Spearman's ρ > 0.8, p value <0.001) between [MP_soil] and [MP_plants] and between the transfer of metals to the plant and to the leaves. Discussion. The sampling location has a differential effect on the [MP] in soil and the transfer to Beta vulgaris. Given the differential effect described, the monitoring and phytoremediation strategies must be adjusted to scenarios with potentially phytotoxic conditions.

De garengeot's hernia: case report

ABSTRACT Introduction: De Garengeot hernia is an entity mainly diagnosed intraoperatively. It is more frequently observed in women and is defined as the presence of the vermiform appendix inside to femoral hernia. Most femoral hernias are identified based on clinical diagnosis, but diagnostic imaging is necessary for confirmation. Ultrasound, for example, is a valuable tool to characterize the anatomy of the hernia and its content, and to establish surgical planning. Case presentation: A 75-year-old woman attended the general surgery department of a high complexity hospital in Bogotá, Colombia, due to a painful mass in the right inguinal region. The initial ultrasound study showed a femoral hernia containing the incarcerated appendix and periappendiceal fluid in the hernial sac. The patient developed chronic appendiceal inflammation, so she underwent femoral hernia repair with mesh and appendectomy without complications, achieving a satisfactory recovery. Conclusion: Clinical examination may be sufficient to confirm the presence of a hernia in a large number of cases when the diagnostic approach involves the search of inguinal masses with pain. However, to facilitate surgical planning, diagnostic imaging, especially ultrasound with high-resolution transducers, is the primary tool to characterize the type of hernia and the contents of the hernial sac.

RESUMEN Introducción. La hernia de Garengeot es una entidad cuyo diagnóstico es principalmente intraoperatorio, se presenta con mayor frecuencia en mujeres y corresponde al hallazgo del apéndice cecal contenido en una hernia femoral. La mayoría de las hernias femorales se identifican mediante diagnóstico clínico, pero para su verificación es importante hacer una valoración con imágenes diagnósticas: el ultrasonido, por ejemplo, es una herramienta valiosa para caracterizar la anatomía de la hernia y su contenido, y para establecer el planeamiento quirúrgico. Presentación de caso. Mujer de 75 años quien asistió al servicio de cirugía general de un hospital de alta complejidad de Bogotá, Colombia, por presentar una masa dolorosa en región inguinal derecha. El estudio ecográfico inicial mostró una hernia femoral conteniendo el apéndice cecal con septos internos que separaban el líquido dentro del saco herniario. La paciente presentó inflamación crónica en el apéndice, por lo que se le practicó herniorrafía femoral con malla y apendicectomía sin complicaciones y con las cuales tuvo una recuperación satisfactoria. Conclusiones. El examen clínico puede ser suficiente para confirmar la presencia de una hernia en un gran número de casos cuando se hace el abordaje diagnóstico de masas inguinales con presencia de dolor; sin embargo, las imágenes diagnósticas, especialmente la ecografía con transductores de alta resolución, constituyen la herramienta de primera línea para caracterizar el tipo de hernia y el contenido del saco herniario, lo que facilita la planeación quirúrgica.

Implementación de un programa de alimentación escolar en una institución educativa durante la pandemia, Bogotá, 2021 / Implementation of a school feeding program in an educational institution during the pandemic, Bogotá, 2021

RESUMEN Objetivo El Programa de Alimentación Escolar (PAE) en Colombia brinda un complemento alimentario para niños y adolescentes vinculados al sistema educativo público; sin embargo, debido a la pandemia por COVID-19, este tuvo que modificar su modalidad de entrega. Este estudio tuvo como propósito describir las estrategias del Colegio CEDID Ciudad Bolívar al implementar el PAE durante la pandemia por COVID-19. Métodos Diseño metodológico cualitativo basado en entrevistas semiestructuradas a docentes, estudiantes y padres de familias, pertenecientes a este colegio. La información fue analizada de acuerdo con un conjunto de categorías establecidas previamente. Resultados Los participantes coinciden en que el traslado de los padres por pérdida de empleo y el no tener dispositivos tecnológicos, influye en la deserción escolar. Por otra parte, el colegio se acogió a la modalidad transitoria del PAE, entregando bonos redimibles por mercado; sin embargo, afirman que no todos lograron acceder a este por desconocimiento del trámite. Se resalta por los participantes que es una ayuda alimentaria, económica y que logra beneficiar a toda la familia, pero se evidencia el alto costo de los alimentos, el desabastecimiento y las dificultades a la hora de redimirlos. Conclusiones A pesar de la pandemia, la institución ha hecho esfuerzos para adaptar el PAE a las circunstancias epidemiológicas a fin de enfrentar el riesgo de deserción escolar y garantizar el complemento alimentario para los estudiantes, siendo valorado por ellos y sus familias.

ABSTRACT Objective The School Feeding Program (PAE, by its initials in Spanish) in Colombia provides a food supplement for children and adolescents enrolled in the public educational system; however, due to the COVID-19 pandemic, its delivery modality had to be modified. The purpose of this study was to describe the strategies of the CEDID Ciudad Bolívar School to implement the PAE during the COVID-19 pandemic. Methods Methodological design based on semi-structured interviews with teachers, students and parents of families belonging to this school. The information was analyzed according to a set of previously established categories. Results The participants agree that the transfer of parents due to loss of employment and not having technological devices influences school dropout. On the other hand, the school took advantage of the transitory modality of the PAE, delivering bonds redeemable by market; however, they affirm that not all were able to access it, due to ignorance of the process. It is highlighted by the participants that it is a food aid, it is economic, and that it manages to benefit the whole family, but the high cost of food, the shortage of supplies, and the difficulties when it comes to redeeming it are evident. Conclusions Despite the pandemic, the institution has made efforts to adapt the PAE to epidemiological circumstances, in order to face the risk of school dropout and guarantee the food supplement for students, being valued by them and their families.

Adherencia a la ruta de atención en salud materno-perinatal en una institución hospitalaria en Valledupar, Colombia / Adherence to maternal-perinatal health care route in a hospital institution in Valledupar, Colombia

RESUMEN Objetivo Evaluar la adherencia de médicos y enfermeros a la ruta integral de atención materno-perinatal (RMP) en el Hospital Eduardo Arredondo Daza (HEAD) de Valledupar, Colombia, 2021. Materiales y Métodos Investigación cuantitativa, descriptiva y transversal. Se aplicó una encuesta virtual a los profesionales de la salud que desarrollan la RMP. Adicional- mente, se usó una lista de chequeo a 505 historias clínicas (HC), evaluadas mediante los criterios de Cumple (C), No Cumple (NC) y No Aplica (NA) y confrontadas con un formato diseñado previamente por el HEAD. Resultados La encuesta fue respondida por los 12 profesionales de la salud a cargo de la RMP. Un 58,3% tienen dificultades en la implementación de la RMP, el 91,7% de ellos resalta la importancia de recibir capacitaciones y el 45,5% solicita que estas capacitaciones tengan una frecuencia de 2 veces al año; en la evaluación de las historias clínicas, la adherencia fue de 77%. Discusión La adherencia por parte de los profesionales a la RMP es deficiente. Se requiere fortalecer el entrenamiento y la capacitación para mejorar la ejecución de la ruta.

ABSTRACT Objective To evaluate the adherence of doctors and nurses to the maternal perinatal care route (RMP, by its initials in Spanish) of the Eduardo Arredondo Daza Hospital (HEAD, by its initials in Spanish), 2021. Materials and Methodos Quantitative, descriptive, and cross-sectional research. A virtual survey was applied to the 12 professionals who develop the RMP. In addition, a checklist was used for 505 medical records (HC), evaluated by the criteria of Compliant (C), Does Not Comply (NC, by its initials in Spanish) and Does Not Apply (NA, by its initials in Spanish), confronted with a format previously designed by the HEAD. Results The survey was answered by the 12 professionals in charge of RMP. 58.3% have difficulties in the implementation of the RMP, 91.7% of them highlight the importance of receiving training, and 45.5% request that these trainings have a frequency of 2 times a year; in the evaluation of medical records, adherence was 77%. Discussion The adherence by professionals to the RMP is weak. Better training is required to improve implementation of the route.

An OxPLORE Initiative Evaluating Children's Surgery Resources Worldwide: A Cross-sectional Implementation of the OReCS Document.

BACKGROUND: The Global Initiative for Children's Surgery (GICS) group produced the Optimal Resources for Children's Surgery (OReCS) document in 2019, listing standards of children's surgical care by level of healthcare facilities within low resource settings. We have previously created and piloted an audit tool based on the OReCS criteria in a high-income setting. In this study, we aimed to validate its use in identifying gaps in children's surgery provision worldwide. METHODS: Our OReCS audit tool was implemented in 10 hospitals providing children's surgery across eight countries. Collaborators were recruited via the Oxford Paediatrics Linking Our Research with Electives (OxPLORE) international network of medical students and trainees. The audit tool measured a hospital's current capacity for children's surgery. Data were analysed firstly to express the percentage of 'essential' criteria met for each specialty. Secondly, the 'OxPLORE method' was used to allocate each hospital specialty a level based on procedures performed and resources available. A User Evaluation Tool (UET) was developed to obtain feedback on the ease of use of the tool. RESULTS: The percentage of essential criteria met within each category varied widely between hospitals. The level given to hospitals for subspecialties based on OReCS criteria often did not reflect their self-defined level. The UET indicated the audit tool was practicable across multiple settings. CONCLUSIONS: We recommend the use of the OReCS criteria to identify areas for local hospital improvement and inform national children's surgical plans. We have made informed suggestions to increase usability of the OReCS audit tool.

Malaria in populations with mining occupation, Colombia, 2012-2018 / [Malaria en poblaciones con ocupación minera, Colombia, 2012-2018].

Introduction: Malaria represents one of the biggest public health challenges, mainly in poor countries. Colombia has social characteristics such as migration, informal work, and economic shortages that favor illegal mining activities. The study of the malaria situation in these areas would allow establishing the bases for its prevention, control, and treatment in the existing public health programs. Objective: To describe the malaria situation in Colombian mining populations between 2012 and 2018. Materials and methods. We conducted a retrospective descriptive study with graphs and maps. For the statistical analysis, we used Pearson´s correlation and Moran's index. Results. From 2012 to 2018, 44,032 cases of malaria were reported in the mining population, 43,900 of uncomplicated malaria and 132 of complicated malaria, and three deaths, two due to Plasmodium vivax and one due to mixed infection. During this period, there was a decrease of 44.7% in cases. The risk rate in 2012 was 2.5 cases x 1000 inhabitants; 87.3% of cases were in men, and 37.9% corresponded to the 20 to 29-year-old age group while 46.7% were AfroColombians. We found a possible moderate positive linear correlation: The greater the mining activity, the greater the number of malaria cases. The global Moran index indicated a significant spatial grouping of cases in mining activities in Colombian Pacific municipalities. Conclusions. The case notification decrease during this period could be attributed to an underreporting of the public health surveillance system (Sivigila) system, as most miners do not have formal jobs, which prevents them from accessing health services. A cohort study is recommended in endemic areas to establish a direct relationship between mining exploitation and the occurrence of malaria cases.

Introducción. La malaria representa uno de los mayores desafíos de salud pública, principalmente en los países pobres. Ciertas características sociales de Colombia, como la migración, el trabajo informal y la escasez económica, favorecen la minería ilegal. El análisis de la situación de la malaria en estas áreas permite establecer una guía para la prevención, el control y el tratamiento de la enfermedad en los programas de salud pública existentes. Objetivo. Describir la situación de la malaria en las poblaciones mineras colombianas entre el 2012 y el 2018. Materiales y métodos. Se hizo un estudio descriptivo y retrospectivo que incluyó la creación de gráficos y mapas. Para el análisis estadístico se utilizaron la correlación de Pearson y el índice de Moran. Resultados. Entre el 2012 y el 2018, se notificaron 44.032 casos de malaria en la población minera, 43.900 de malaria no complicada y 132 de malaria complicada, así como tres muertes, dos por Plasmodium vivax y una por infección mixta. Hubo una disminución del 44,7 % de los casos en el período evaluado. La tasa de riesgo en el 2012 fue de 2,5 casos por 1.000 habitantes; el 87,3 % de los casos se presentó en hombres y el 37,9 % en personas entre los 20 y los 29 años, en tanto que el 46,7 % de la población estudiada estaba conformada por afrocolombianos. Se encontró una posible correlación lineal positiva moderada entre mayor la actividad minera, mayor el número de casos de malaria en mineros. El índice de Moran global evidenció una agrupación espacial significativa de los casos de malaria en zonas con industria minera en los municipios del Pacífico colombiano. Conclusiones. La disminución en la notificación de casos durante el período evaluado podría atribuirse a un subregistro del Sistema de Vigilancia en Salud Pública (Sivigila), ya que la mayoría de los mineros no tienen trabajos formales, lo que dificulta su acceso a los servicios de salud. Se recomienda un estudio de cohorte en áreas endémicas para establecer una relación directa entre la explotación minera y la presencia de casos de malaria.

Malaria en poblaciones con ocupación minera, Colombia, 2012-2018 / Malaria in populations with mining occupation, Colombia, 2012-2018

Resumen | Introducción. La malaria representa uno de los mayores desafíos de salud pública, principalmente en los países pobres. Ciertas características sociales de Colombia, como la migración, el trabajo informal y la escasez económica, favorecen la minería ilegal. El análisis de la situación de la malaria en estas áreas permite establecer una guía para la prevención, el control y el tratamiento de la enfermedad en los programas de salud pública existentes. Objetivo. Describir la situación de la malaria en las poblaciones mineras colombianas entre el 2012 y el 2018. Materiales y métodos. Se hizo un estudio descriptivo y retrospectivo que incluyó la creación de gráficos y mapas. Para el análisis estadístico se utilizaron la correlación de Pearson y el índice de Moran. Resultados. Entre el 2012 y el 2018, se notificaron 44.032 casos de malaria en la población minera, 43.900 de malaria no complicada y 132 de malaria complicada, así como tres muertes, dos por Plasmodium vivax y una por infección mixta. Hubo una disminución del 44,7 % de los casos en el período evaluado. La tasa de riesgo en el 2012 fue de 2,5 casos por 1.000 habitantes; el 87,3 % de los casos se presentó en hombres y el 37,9 % en personas entre los 20 y los 29 años, en tanto que el 46,7 % de la población estudiada estaba conformada por afrocolombianos. Se encontró una posible correlación lineal positiva moderada entre mayor la actividad minera, mayor el número de casos de malaria en mineros. El índice de Moran global evidenció una agrupación espacial significativa de los casos de malaria en zonas con industria minera en los municipios del Pacífico colombiano. Conclusiones. La disminución en la notificación de casos durante el período evaluado podría atribuirse a un subregistro del Sistema de Vigilancia en Salud Pública (Sivigila), ya que la mayoría de los mineros no tienen trabajos formales, lo que dificulta su acceso a los servicios de salud. Se recomienda un estudio de cohorte en áreas endémicas para establecer una relación directa entre la explotación minera y la presencia de casos de malaria.

Abstract | Introduction: Malaria represents one of the biggest public health challenges, mainly in poor countries. Colombia has social characteristics such as migration, informal work, and economic shortages that favor illegal mining activities. The study of the malaria situation in these areas would allow establishing the bases for its prevention, control, and treatment in the existing public health programs. Objective: To describe the malaria situation in Colombian mining populations between 2012 and 2018. Materials and methods. We conducted a retrospective descriptive study with graphs and maps. For the statistical analysis, we used Pearson's correlation and Moran's index. Results. From 2012 to 2018, 44,032 cases of malaria were reported in the mining population, 43,900 of uncomplicated malaria and 132 of complicated malaria, and three deaths, two due to Plasmodium vivax and one due to mixed infection. During this period, there was a decrease of 44.7% in cases. The risk rate in 2012 was 2.5 cases x 1000 inhabitants; 87.3% of cases were in men, and 37.9% corresponded to the 20 to 29-year-old age group while 46.7% were AfroColombians. We found a possible moderate positive linear correlation: The greater the mining activity, the greater the number of malaria cases. The global Moran index indicated a significant spatial grouping of cases in mining activities in Colombian Pacific municipalities. Conclusions. The case notification decrease during this period could be attributed to an underreporting of the public health surveillance system (Sivigila) system, as most miners do not have formal jobs, which prevents them from accessing health services. A cohort study is recommended in endemic areas to establish a direct relationship between mining exploitation and the occurrence of malaria cases.

Contamination of staple crops by heavy metals in Sibaté, Colombia.

Heavy metal contamination in water resources, soil, and food sources is an issue that compromises food safety in Sibaté, Colombia. In the present study concentration of heavy metals [HMs], such as Cu, As, Pb, Cr, Zn, Co, Cd and Ni, present in vegetables included in the typical Colombian diet were measured. The study was conducted as follows: samples of parsley, artichoke and carrots produced in a location near the Muña dam were collected, where the Bogotá River water is treated for use as a water resource. To determine food safety, national and international [HMs] established limits were compared with quantified [HMs] in samples of different vegetable parts and of the surrounding soil. Fresh samples were separated in their respective parts for cold acid digestion with HCl and HNO3 (1:1) for 15 days. Heavy metal mean ± standard error (SE) were as follows (mg/kg) As 2.36 ± 0.185, Cd 0.16 ± 0.009, Co 0.43 ± 0.019, Cr 12.1 ± 0.453, Cu 13.1 ± 1.68, Ni 0.00, Pb 7.07 ± 0.482 and Zn 3.976 ± 0.332. Cd, Cr, As, Co and Ni showed high transfer factor in Cynara scolymus. Moreover, high Pb, Cu and Zn transfer factor were present in Petroselinum crispum. Except for Daucus carota roots, there was a high metal transfer specifically in Petroselinum crispum leaves and other different plant parts, with high transfer factor for Cr, As, Co, Pb, Cu and Zn.

First three Escherichia coli isolates harbouring mcr-1 in Uruguay.

OBJECTIVE: This report described the first Escherichia coli (E. coli) isolates harbouring mcr-1 in Uruguay. METHODS: Three E. coli isolates were obtained from blood, urine and rectal swabs from different patients in two hospitals. Extended-spectrum ß-lactamases (ESBL), plasmid-encoded (pAmpC) ß-lactamases, plasmid-mediated quinolone resistance (PMQR) genes, class 1 integrons, and mcr-1, mcr-2 and mcr-3 were sought and characterised in three E. coli isolates. Transfer of resistance determinants was assessed by conjugation. Clonality was analysed by multilocus sequence typing. RESULTS: All isolates were categorised as being colistin-resistant and the mcr-1 gene was detected. Two isolates were also resistant to oxyimino cephalosporins: one on account of blaCMY-2 and the other due to blaCTX-M-15, the latter also harbouring transferable quinolone-resistance genes (aac(6')Ib-cr and qnrB). All mcr-1 genes were transferred by conjugation to recipient strains. The mcr-1-bearing isolates belonged to sequence types ST10, ST93 and ST5442. CONCLUSIONS: ST10 is considered as a high-risk clone worldwide. This type of mcr-1-harbouring clone is a major concern for human and animal health and must be under close surveillance. This study detected the presence of mcr-1 for the first time in Uruguay, albeit in an allodemic manner, associated with different antibiotic-resistance genes and from diverse clinical contexts. Considering that colistin is often the last therapeutic option available for multidrug-resistant Gram-negative bacilli infections, it is important to maximise precautions to avoid dissemination of isolates carrying mcr-1.

Análisis de situación en salud: su importancia en la implementación por las entidades territoriales de Colombia, 2016 / Health situation analysis: its importance in the implementation by Colombian territorial entities, 2016

Para las autoridades en salud en todos los niveles de decisión nacional o territorial, es fundamental contar con información que les permita tomar decisiones para responder las necesidades de sus poblaciones. En este sentido, el Análisis de Situación de Salud (ASIS) es una metodología que facilita la identificación y la explicación de las condiciones de salud y de enfermedad, generando información pertinente para la formulación de políticas y la planificación en salud. Las entidades territoriales (ET) departamentales en Colombia están implementando el ASIS; por consiguiente, se ha examinado el proceso de construcción del mismo, sus mecanismos de divulgación y de uso, siguiendo los lineamientos que ha establecido el Ministerio de Salud y Protección Social (MSPS). Es importante fortalecer esta metodología, mejorando las capacidades territoriales para su desarrollo, desde una perspectiva de los determinantes sociales de la salud (DSS).

Improving immunization data quality in Peru and Mexico: Two case studies highlighting challenges and lessons learned.

INTRODUCTION: The Global Vaccine Action Plan and the Regional Immunization Action Plan of the Americas call for countries to improve immunization data quality. Immunization information systems, particularly electronic immunization registries (EIRs), can help to facilitate program management and increase coverage. However, little is known about efforts to develop and implement such systems in low- and middle-income countries. We present the experiences of Mexico and Peru in implementing EIRs. METHODS: We conducted case studies of an EIR in Mexico and of a population registry in Peru. Information was gathered from technical documents, stakeholder focus groups, site visits, and semi-structured interviews of national stakeholders. We organized findings into narratives that emphasized challenges and lessons learned. RESULTS: Mexico built one of the world's first EIRs, incorporating novel features such as local-level tracking of patients; however, insufficient resources and poor data registration practices led to the system's discontinuation. Peru created an information system to improve affiliation to social programs, including the immunization program and quality of demographic data. Mexico's experience highlights lessons in failed sustainability of an EIR and a laudable effort to reform a country's information system. Peru's demonstrates that attempts to improve health and other data may strengthen health systems, including immunization data. Major challenges in information system implementation and sustainability in Peru and Mexico related to funding, clear governance structures, and resistance among health workers. DISCUSSION: These case studies reinforce the need for countries to ensure adequate funding, plans for sustainability, and health worker capacity-building activities before implementing EIRs. They also suggest new approaches to implementation, including economic incentives for sub-national administrative levels and opportunities to link efforts to improve immunization data with other health and political priorities. More information on best practices is needed to ensure the successful adoption and sustainability of immunization registries in low- and middle-income countries.

Motivos de no vacunación en menores de cinco años en cuatro ciudades colombianas

[RESUMEN]. Objetivo. Conocer las barreras y los motivos de no vacunación en niños y niñas menores de cinco años en algunas ciudades de Colombia. Métodos. Diseño cualitativo basado en entrevistas y grupos focales a personal de salud y cuidadores en cuatro ciudades colombianas seleccionadas de acuerdo a diferentes coberturas de vacunación y densidades poblacionales. Resultados. Se identificaron diferentes factores que pueden influir en el incumplimiento de los esquemas de vacunación en los dos municipios con baja cobertura, como el temor a la reacción posvacunal, las condiciones socioeconómicas, geográficas y de seguridad de la población, las condiciones laborales del personal de vacunación, los problemas administrativos y económicos y el desarrollo precario de los sistemas de información. Conclusiones. Desde el punto de vista cualitativo, los equipos de vacunación y los cuidadores destacaron aspectos sociales e institucionales que contribuyen o limitan el cumplimiento de las coberturas de vacunación en las ciudades que participaron en el estudio.

[ABSTRACT]. Objective. Identify barriers and reasons why children under 5 do not get vaccinated in some Colombian cities. Methods. Qualitative design based on interviews and focus groups of health workers and caregivers in four Colombian cities selected according vaccination coverage and population densities. Results. Different factors were identified that may hinder completion of vaccination schedules in the two municipalities with low coverage, such as fear of a post-vaccination reaction, socioeconomic and geographical conditions and population safety, working conditions of the vaccination staff, administrative and economic problems, and precarious information systems. Conclusions. From a qualitative standpoint, the vaccination teams and caregivers pointed to social and institutional issues that may hinder vaccination coverage in the cities that participated in the study.

[RESUMO]. Objetivo. Conhecer as barreiras e os motivos por que não são vacinadas crianças menores de cinco anos em algumas cidades da Colômbia. Métodos. Estudo de delineamento qualitativo baseado em entrevistas e grupos focais conduzido com profissionais da saúde e cuidadores em quatro cidades colombianas selecionadas segundo a cobertura de vacinação e a densidade populacional. Resultados. Foram identificados diversos fatores para não serem seguidos os esquemas de vacinação nos dois municípios com baixa cobertura: receio de reação pós-vacinal, condições socioeconômicas, geográficas e de segurança da população, condições laborais do pessoal encarregado pela vacinação, problemas administrativos e econômicos e situação precária dos sistemas de informação. Conclusão. Do ponto de vista qualitativo, as equipes de vacinação e os cuidadores destacaram aspectos sociais e institucionais que contribuem para, ou limitam, o cumprimento das metas de cobertura de vacinação nas cidades participantes do estudo.