Social determination of alcohol consumption among Indigenous peoples in Colombia: a qualitative meta-synthesis.

BACKGROUND: Alcohol consumption is a social phenomenon that involves society, groups, and individuals from different cultures around the world. Among some Indigenous groups located in Colombia, South America, alcohol consumption has been present in their lives, where contradictory processes occur and generate public health attention. We aimed to analyze qualitative research findings on alcohol consumption among Indigenous peoples in Colombia. METHODS: This article used the qualitative meta-synthesis methodology, which included: (a) comprehensive search strategy, (b) appraisal of qualitative research reports, (c) findings classification, and (d) synthesis. Databases were searched for papers published from 2004 to 2019 in SCOPUS, LILACS, PROQUEST, and JSTOR, among other sources of information. A total of 2,159 papers were reviewed and finally, 13 studies were included in this meta-synthesis. The synthesis of findings included a constant comparative analysis and also aimed for the articulation of its findings to alternative perspectives in a predefined matrix. RESULTS: Nine Indigenous ethnic groups of Colombia were represented in the 13 articles analyzed. From the analysis emerged the symbolic approach "Alcohol: a chameleon that unpredictable society colors" as the meta-theme of this research. This reflects four social processes that influence interaction with alcohol: Dynamic Systems Mergers (Indigenous system, influence of non-Indigenous system); Diverse Authority Spheres (parenting, Indigenous authority, school, university, religious and spiritual, traditional medicine); Between Transculturation and Interculturality (cultural crises effects and dynamism); and the Paradoxes of the Normalization of Alcohol (reasons, functions, and types of alcohol consumption). Likewise, these results support the social determination of health and sociocultural epidemiology perspectives, as being an adequate way of explaining a complex phenomenon. CONCLUSION: Alcohol consumption among Indigenous peoples in Colombia is a social construction. Alcohol acts as an instrument, which is present in the changing relationships and tensions of social processes. This is reflected in harmonies, or disharmonies, in the life of Indigenous Colombians, which take place in a historical, sociocultural, economic, and political context. The results provide a reference point to guide practice and research but also reiterate the need to include the social determination of health perspective in public policies, as a path to the understanding of alcohol consumption.

Experiences of women with Zika virus (ZIKV) versus the provision of health services in two cities in Colombia: A qualitative study.

BACKGROUND: In February 2016, the World Health Organization (WHO) declared the epidemic of the ZIKA virus (ZIKV) in Latin America to be a public health emergency. In Colombia, 11,944 pregnant women registered a ZIKV infection during the epidemic. So far, little is known about the experiences of women infected with ZIKV during their pregnancy, especially those relating to the provision of health services during the period of the epidemic. OBJECTIVE: To explore the experiences of pregnant women diagnosed with ZIKV infection about the provision of health services in two Colombian cities, considering the perspective of sexual and reproductive rights. METHODS: Qualitative study under the grounded theory approach, which uses semi-structured interviews as tools to explore the biographical experience of mothers during their gestation process and ZIKV infection, dividing the interview into two broad categories: before and during pregnancy. RESULTS: Twenty-two women were interviewed, 10 in Cali and 12 in Villavicencio. The average age at the time of pregnancy was 27.6 years. Most women were not planning at the time of pregnancy and the pregnancy was unwanted. Most campaigns focused on mosquito eradication rather than on sexual and reproductive health campaigns. The quality of health care was not sufficient, adequate, or appropriate. Also, the breakdown of the health system to deal with the pandemic was also noted. Some women were treated with disrespect by health professionals. Voluntary termination of pregnancy was inadequately advised, and women lost autonomy regarding decisions about their health. CONCLUSIONS: In the health care of ZIKV epidemics, it is necessary to include the gender perspective, more specifically, sexual and reproductive rights. In addition, these epidemics must be addressed through a comprehensive, appropriate, and not fragmented health system, in which sexual and reproductive rights must be mainstreamed in all health promotion and prevention programs.

Integrated Management of Childhood Illnesses implementation-related factors at 18 Colombian cities.

BACKGROUND: Integrated Management of Childhood Illnesses (IMCI) is a strategy developed by the World Health Organization (WHO) and UNICEF in 1992. It was deployed as an integrated approach to improve children's health in the world. This strategy is divided into three components: organizational, clinical, and communitarian. If the Integrated Management of Childhood Illnesses implementation-related factors in low- and middle-income countries are known, the likelihood of decreasing infant morbidity and mortality rates could be increased. This work aimed to identify, from the clinical component of the strategy, the implementation-related factors to Integrated Management of Childhood Illnesses at 18 Colombian cities. METHODS: A quantitative cross-sectional study was performed with a secondary analysis of databases of a study conducted in Colombia by the Public Health group of Universidad de Los Andes in 2016. An Integrated Care Index was calculated as a dependent variable and descriptive bivariate and multivariate analyses to find the relationship between this index and the relevant variables from literature. RESULTS: Information was obtained from 165 medical appointments made by nurses, general practitioners, and pediatricians. Health access is given mainly in the urban area, in the first level care and outpatient context. Essential medicines availability, necessary supplies, second-level care, medical appointment periods longer than 30 min, and care to the child under 30 months are often related to higher rates of Integrated Care Index. CONCLUSION: Health care provided to children under five remains incomplete because it does not present the basic minimums for the adequate IMCI's implementation in the country. It is necessary to provide integrated care that provides medicine availability and essential supplies that reduce access barriers and improve the system's fragmentation.

Cuando nos solicitaron escribir este editorial, pensamos que nos adentraríamos en espacios que, por tradición, han sido ocupados por neumólogos, infectólogos y otras especialidades o expertos del sector de la salud que se dedican a trabajar con tuberculosis. [Editorial] / When we were asked to write this editorial, we thought we would enter spaces that, by tradition, have been occupied by pulmonologists, infectologists and other specialties or experts in the health sector who are dedicated to working with tuberculosis. [Editorial]

La tuberculosis, que se considera un indicador clave del índice de salud de una población y del desarrollo, evidencia las condiciones de vida de las poblaciones, sus condiciones económicas, sociales y culturales y de las serias dificultades para el acceso a los servicios de salud, entre otros. Como ven, se trata sobre todo de una muestra relacionada con la pobreza que vive la población. La mayoría de muertes por tuberculosis son médicamente prevenibles, resultado de un complejo proceso inscrito en la estructura social influenciado por los determinantes sociales en salud. En el ámbito global, la tuberculosis continúa siendo un problema de salud pública, que refiere cerca de nueve millones de casos nuevos. En Colombia se presentó una tasa de incidencia de 25,3 casos por 100.000 habitantes en 2011, en especial en Valle del Cauca, Bogotá y Antioquia, que suman un 40% de los casos nuevos del país

Tuberculosis, which is considered a key indicator of a population's health and development index, is evidence of the living conditions of populations, their economic, social and cultural conditions and of the serious difficulties in accessing health services, among others. As you can see, it is above all a sample related to the poverty experienced by the population. Most deaths from tuberculosis are medically preventable, the result of a complex process embedded in the social structure and influenced by the social determinants of health. Globally, tuberculosis continues to be a public health problem, with nearly nine million new cases. In Colombia, the incidence rate was 25.3 cases per 100,000 inhabitants in 2011, especially in Valle del Cauca, Bogota and Antioquia, which account for 40% of new cases in the country