Status and trends in research on clinical prediction models for severity risk stratification in confirmed Covid-19 patients / Estado y tendencias en la investigación sobre modelos de predicción clínica para la estratificación del riesgo de severidad en pacientes confirmados de Covid-19 / Situação e tendências em pesquisas sobre modelos de previsão para a estratificação do risco de gravidade em pacientes confirmado de Covid-19

Introduction: Previous knowledge in the scientific literature on clinical prediction models in patients with Covid-19 may be useful for the development of new research. Objective: We describe the sources, authors, documents and key issues that are part of the research front. Identify which models, outcome variables, predictors and algorithms have been relevant. We Identify to what extent the available models could meet the quality attributes and what characteristics they must have to be applicablein the Cuban context. Methods: A review and scientometric analysis was carried out on the research in development and validation of clinical predictive models for Covid-19. The scientometric indicators were used and a thematic map was made for the analysisof the conceptual structure of the subject.Results: The subject was of great interest with papers published in the highest level journals. It is possible to distinguish a context of low and high risk application according to the primary and secondary health levels. The systematic reviewpublished by Wynants et al. was the publication with the greatest impact and an important source for the identification of models, main components, as well as possible causes of bias.Conclusions: The literature recognizes that most of the published models are not recommended for general use in clinical practice, so it is an open research front. However, the data obtained could be useful for the development and validation ofCuban models.

Introducción: El conocimiento previo en literatura científica sobre modelos de predicción clínica en pacientes con Covid-19 puede ser de utilidad para el desarrollo de nuevas investigaciones.Objetivo: Describir las fuentes, autores, documentos y temas clave que forman parte del frente de investigación. Identificar qué modelos, variables de resultado, predictores y algoritmos han resultado relevantes. Identificar en qué medida los modelos disponibles podrían cumplir con los atributos de calidad y qué características deberían poseer para ser aplicables en el contexto cubano.Métodos: Se realizó una revisión y análisis cienciométrico sobre la investigación en desarrollo y validación de modelos de predicción clínica en Covid-19. Se utilizaron indicadores cienciométricos y se realizó un mapa temático para el análisis de la estructura conceptual del tema.Resultados: El tema resultó de gran interés con trabajos publicados en las revistas de más alto nivel. Es posible distinguir un contexto de aplicación de bajo y alto riesgo acorde con el nivel primario y secundario de salud. La revisión sistemática publicada por Wynants y colaboradores constituyó la publicación de mayor impacto y una fuente importante para la identificación de modelos, principales componentes, así como posibles causas de sesgos.Conclusiones: La literatura reconoce que la mayoría de los modelos publicados no se recomiendan para su uso generalizado en la práctica clínica por lo que es un frente de investigación abierto. Sin embargo, los datos obtenidos podrían ser de utilidad para el desarrollo y validación de modelos en Cuba.

Introdução: O conhecimento prévio na literatura científica sobre modelos de predição clínica em pacientes com Covid-19 pode ser útil para o desenvolvimento de novas pesquisas.Objetivo: Descrever as fontes, autores, documentos e questões-chave que fazem parte da frente de pesquisa. Identifique quais modelos, variáveis ​​de resultado, preditores e algoritmos foram relevantes. Identificar em que medida os modelos disponíveis poderiam atender aos atributos de qualidade e quais características deveriam ter para serem aplicáveis ​​no contexto cubano.Métodos: Foi realizada uma revisão e análise cientométrica sobre as pesquisas em desenvolvimento e validação de modelos de predição clínica em Covid-19. Foram utilizados indicadores cientométricos e elaborado um mapa temático para análise da estrutura conceitual do assunto.Resultados: O assunto foi de grande interesse com artigos publicados em periódicos de alto nível. É possível distinguir um contexto de aplicação de baixo e alto risco de acordo com o nível primário e secundário de saúde. A revisão sistemática publicada por Wynants et al., foi a publicação de maior impacto e uma fonte importante para a identificação de modelos, componentes principais, bem como possíveis causas de viés.Conclusões: A literatura reconhece que a maioria dos modelos publicados não são recomendados para uso geral na prática clínica, por isso é uma frente de pesquisa aberta. No entanto, os dados obtidos podem ser úteis para o desenvolvimento e validação de modelos em Cuba.

Identification of patients with very low risk of transition to severity in confirmed covid-19. Cuba. March 2020-May 2021 / Identificación de pacientes de muy bajo riesgo de transición a la severidad en confirmados de covid-19. Cuba. 2020- 2021 / Identificação de pacientes com baixíssimo risco de transição para gravidade em casos confirmados de covid-19. Cuba. 2020-2021

Introduction: Covid-19 pandemic, threatened health worldwide, and overhelmed systemshealthcare in many countries. Performing and adequate identification of subjects with verylow risk to develop a severe form of the disease must result very cost-effective.Objective: To identify patients with very low risk of transition to severity in subjectsconfirmed with Covid-19 in Cuba.Methods: An environmental study was carried out based on the Cuban National Registerof confirmed Subjects covid-19. Between march 11th, 2020 and may 31st 2021, 10600persons were recorded. Admission in ICU and mortality related to covid-19, both measured30 days after disease confirmation, were the variables analyzed. As predictors, age and comorbidities were chosen. A classification tree ­ algorithm was applied to identify risk strata. To every stratum, its volume, the risk of transition to severity and the explained risk were calculated.Results: Subjects less than 65 years with no comorbidities (85,8% of the total) had a verylow risk (0,2%) of admission in ICU and death. Adjusted models showed a good calibration and discriminant ability.Conclusions: The study allowed the identification of subjects with very low risk of transition to severity. They could be followed by primary health care units with home surveillance and symptomatic treatment. The approaches used, permit the improvement of assigning admissions to different health care units' optimizing limited health resources.

Introducción: La pandemia de covid-19, amenaza para la salud mundial, desbordó los sistemas de salud en muchos países. Realizar una adecuada clasificación del riesgo de transmisión resulta de vital importancia. Objetivo: Identificar pacientes con muy bajo riesgo de transición a la severidad en pacientes  confirmados de covid-19 en Cuba. Métodos: Se realizó un estudio ecológico  que tuvo como base el registro nacional de pacientes confirmados de covid-19.  Se analizaron  10600 individuos entre el 11 de marzo de 2020 y el 31 de mayo de 2021. Las variables de respuesta seleccionadas fueron admisión en UCI y mortalidad, ambas medidas a los 30 días de la confirmación de la enfermedad. Los predictores fueron la edad  y la presencia de comorbilidades.  Se aplicó  un algoritmo de árboles de clasificación para identificar estratos de riego. Se determinó para cada estrato, su volumen, el riesgo de transición a la severidad y el riesgo explicado. Resultados: Se comprobó que los pacientes con  edad menor de 65 años y sin comorbilidades, que concentraba el 86,8% de la muestra, tenían muy bajo riesgo (0,2%)  de  admisión en UCI y de muerte. Los modelos demostraron una buena calibración y discriminación. Conclusiones: El estudio permitió identificar individuos con muy bajo riesgo de transición a la severidad seguidos desde la atención primaria de salud con  ingreso en el hogar y tratamiento sintomático. La metodología propuesta basado en la evidencia permitió perfeccionar los procedimientos de derivación hacia los distintos escenarios  y priorizar recursos de salud limitados. 

Introdução: A pandemia de covid-19, uma ameaça global à saúde, sobrecarregou os sistemas de saúde de muitos países. A realização de uma classificação adequada do risco de transmissão é de vital importância. Objetivo: Identificar pacientes com baixíssimo risco de transição para gravidade em pacientes confirmados com covid-19 em Cuba. Métodos: Foi realizado um estudo ecológico com base no registro nacional de pacientes confirmados com covid-19. Foram analisados ​​10.600 indivíduos entre 11 de março de 2020 e 31 de maio de 2021. As variáveis ​​de resposta selecionadas foram admissão na UTI e mortalidade, ambas medidas 30 dias após a confirmação da doença. Os preditores foram idade e presença de comorbidades. Um algoritmo de árvore de classificação foi aplicado para identificar os estratos de irrigação. Foi determinado para cada estrato, o seu volume, o risco de transição para gravidade e o risco explicado.Resultados: Verificou-se que os pacientes com menos de 65 anos e sem comorbidades, que perfizeram 86,8% da amostra, apresentaram risco muito baixo (0,2%) de internação em UTI e óbito. Os modelos demonstraram boa calibração e discriminação.Conclusões: O estudo permitiu identificar indivíduos com baixíssimo risco de transição para a gravidade seguidos de cuidados de saúde primários com internamento domiciliário e tratamento sintomático. A metodologia baseada em evidências proposta permitiu refinar os procedimentos de encaminhamento para os diferentes cenários e priorizar os recursos de saúde limitados.

Correction to "Cuban Abdala vaccine: Effectiveness in preventing severe disease and death from COVID-19 in Havana, Cuba; A cohort study" [The Lancet Regional Health - Americas 2022; 16: 100366] https://doi.org/10.1016/j.lana.2022.100366.

[This corrects the article DOI: 10.1016/j.lana.2022.100366.].

Cuban Abdala vaccine: Effectiveness in preventing severe disease and death from COVID-19 in Havana, Cuba; A cohort study.

Background: COVID-19 vaccines have proven safe and efficacious in reducing severe illness and death. Cuban protein subunit vaccine Abdala has shown safety, tolerability and efficacy (92·3% [95% CI: 85·7‒95·8]) against SARS-CoV-2 in clinical trials. This study aimed to estimate Abdala's real-world vaccine effectiveness (VE). Methods: This retrospective cohort study in Havana analyzed Cuban Ministry of Public Health databases (May 12-August 31, 2021) to assess VE in preventing severe illness and death from COVID-19 (primary outcomes). Cox models accounting for time-varying vaccination status and adjusting by demographics were used to estimate hazard ratios. A subgroup analysis by age group and a sensitivity analysis including a subgroup of tested persons (qRT-PCR) were conducted. Daily cases and deaths were modelled accounting for different VE. Findings: The study included 1 355 638 persons (Mean age: 49·5 years [SD: 18·2]; 704 932 female [52·0%]; ethnicity data unavailable): 1 324 vaccinated (partially/fully) and 31 433 unvaccinated. Estimated VE against severe illness was 93·3% (95% CI: 92·1-94·3) in partially- vaccinated and 98·2% (95% CI: 97·9-98·5) in fully-vaccinated and against death was 94·1% (95% CI: 92·5-95·4) in partially-vaccinated and 98·7% (95% CI: 98·3-99·0) in fully-vaccinated. VE exceeded 92·0% in all age groups. Daily cases and deaths during the study period corresponded to a VE above 90%, as predicted by models. Interpretation: The Cuban Abdala protein subunit vaccine was highly effective in preventing severe illness and death from COVID-19 under real-life conditions. Funding: Cuban Ministry of Public Health. Genetic Engineering and Biotechnology Centre.

Nimotuzumab in the Treatment of Inoperable Esophageal Tumors of Epithelial Origin.

Background: Nimotuzumab is a humanized monoclonal antibody that targets the epidermal growth factor receptor. It was approved in Cuba for the indication of inoperable malignant tumors of the esophagus of epithelial origin. The purpose of this study was to evaluate the safety, overall and progression-free survival, clinical response, and quality of life, in adult patients with inoperable esophageal tumors of epithelial origin treated with nimotuzumab in a practical context. Material and Methods. The number of patients who developed adverse events was determined, and the frequency, seriousness, causality, and severity of these adverse events were determined. It also determined the median of survival and progression-free survival and rates at 12 and 24 months and the quality of life. Results: A total of 111 patients were included. The proportion of serious and related AE with the use of nimotuzumab was 1.3%. Most of the related AEs were mild and moderate, and the most frequent AEs were diarrhea, chills, and tremors. New diagnosed patients who received nimotuzumab concurrent with chemotherapy and radiotherapy reached a median OS of 12.2 months (95% CI, 6.9-17.5) and 12- and 24-month survival rates of 51.0% and 17.0%, respectively. Median PFS was 7.8 months (95% CI, 6.2-9.5), and 12- and 24-month PFS rates were 39.3% and 11.2%, respectively. A favorable evolution of the general state of health (p=0.03) was obtained from the beginning of treatment until month 12, with a significant reduction in the appearance of nausea (p=0.009), insomnia (p=0.04), constipation (p=0.04), eating difficulties (p=0.0006), and choking when swallowing (p=0.0001), but increased in dysphagia (p=0.02). Conclusions: The administration of nimotuzumab was safe in the real-world setting. New diagnosed patients that received nimotuzumab concurrent with chemotherapy and radiotherapy reached a higher overall and progression-free survival and better quality of life than the rest of the patients. Trial registration is RPCEC00000215 (Cuban Registry of Clinical Trials; https://registroclinico.sld.cu/en/home). It is registered prospectively on June 30, 2016.

La edad como variable asociada a la gravedad en pacientes con la COVID-19

RESUMEN Introducción: La COVID-19, estremeció al mundo en diciembre de 2019. Desde sus inicios se ha observado que los pacientes de mayor edad son propensos a desarrollar formas graves de la enfermedad. Objetivo: Determinar el papel de la edad como variable asociada a la gravedad en pacientes con la COVID-19. Métodos: Se realizó un estudio analítico retrospectivo de cohorte en 150 pacientes diagnosticados con la COVID-19, desde marzo hasta junio de 2020. Se analizó la gravedad según grupos de edades, mediante un modelo de regresión logística binaria simple. Fueron resumidas variables clínicas y de laboratorio al ingreso hospitalario, para la comparación de 2 grupos de edad a partir del punto de corte óptimo para la edad mediante la curva ROC. Se utilizó el software libre R versión 4.0.2 (22-06-2020) para el procesamiento. Resultados : La edad de los pacientes tuvo un amplio rango; predominó la gravedad de la enfermedad en los grupos de edad avanzada. El punto de corte óptimo calculado fue 71,5; se observó que a partir de los 70 años los pacientes tenían mayor comorbilidad y pruebas de laboratorio alteradas. Igualmente, tuvieron mayor cantidad de síntomas, estadía hospitalaria y número de fallecidos. Conclusiones: La edad constituye un factor de riesgo asociado a la gravedad en pacientes con la COVID-19; aumenta significativamente a partir de los 70 años, cuando coexisten una serie de factores que, unidos a la edad avanzada, juegan un importante papel en el pronóstico.

ABSTRACT Introduction: COVID-19, rocked the world in December 2019. Since its inception, it has been observed that older patients are prone to develop severe forms of the disease. Objective: To determine the role of age as a variable associated with severity in COVID-19 patients. Methods: A retrospective cohort analytical study was conducted in 150 patients diagnosed with COVID-19, during March to June 2020. The severity was analyzed according to age groups, and a simple binary logistic regression model was used. Clinical and laboratory variables at hospital admission were summarized for the comparison of two age groups from the optimal cut-off point for age using the ROC curve. The free software R version 4.0.2 (22-06-2020) was used for processing. Results: The age of the patients had a wide range, with disease severity predominating in the older age groups. The optimal cut-off point calculated was 71.5. Was observed that from 70 years of age onwards patients had greater comorbidity and altered laboratory tests. Likewise, a greater number of symptoms, hospital stay, and number of deaths. Conclusions: Age is a risk factor associated with severity in patients with COVID-19, which increases significantly after 70 years of age, where a series of factors coexist which, together with advanced age, play an important role in the prognosis.

Caracterización clínica y tratamiento de pacientes ingresados por la COVID-19 en terapias intensivascubanas

RESUMEN Introducción: La pandemia por la COVID-19 fue declarada emergencia de salud pública internacional. El conocimiento de los síntomas, comorbilidades y el riesgo según el tratamiento recibido puede contribuir a una mejor clasificación y atención de los pacientes. Objetivo: Caracterizar clínicamente a los pacientes de COVID-19 atendidos en las unidades de terapia intensiva cubanas. Métodos: Estudio observacional retrospectivo de todos los pacientes atendidos en las unidades de terapia intensiva de Cuba en el periodo comprendido entre el 11 de marzo y el 30 de julio de 2020. Se recolectaron datos demográficos, clínicos y de resultados. Se compararon los pacientes fallecidos y recuperados de acuerdo a la prevalencia de las covariables a través de una prueba estándar de chi-cuadrado. Se realizó regresión logística para evaluar las variables predictoras de la mortalidad hospitalaria. Resultados: Se atendieron 175 pacientes, de ellos 106 graves y 69 críticos. Predominó el sexo masculino (52,0 %), mayores de 60 años (67,2 %) con hipertensión arterial (57,0 %). La edad (mayores de 80 años, OR= 9,62, IC95%: 3,16-29,2), el estado al ingreso (OR= 8,32, IC95%: 2.30-30,10) y la inestabilidad hemodinámica (OR=6,9, IC95%:2,96-16,37), se asociaron a un mayor riesgo de fallecimiento. Los pacientes tratados con kaletra, cloroquina, itolizumab o jusvinza incrementaron la supervivencia. El riesgo de fallecimiento en los críticos disminuyó de 80 a 25% con el uso de jusvinza. Conclusiones: La caracterización clínica realizada demuestra la efectividad de los protocolos clínicos empleados en las unidades de terapia intensiva del país.

ABSTRACT Introduction: COVID-19 pandemic was declared an international public health emergency. The knowledge of the symptoms, comorbidities, and the risk associated with the treatment received could contribute to better classification and care of patients. Objective: To clinically characterize COVID-19 patients admitted to the Cuban intensive care units Methods: A retrospective observational study of all patients treated in the Cuban intensive care units from March 11 to July 30, 2020. Demographic, clinical and outcome data were collected. The prevalence of fatal and recovery cases was compared by covariables using the standard chi-square test. A logistic regression was performed to evaluate the predictor variables for in-hospital mortality. Results: A total of 175 patients were treated, including 106 acutely ill and 69 critically ill. Patients were predominantly male (52.0%), over 60 years old (67.2%) and had hypertension (57.0%). Age (over 80 years old, OR= 9.62, 95% CI: 3.16-29.2), health status at admission (OR= 8.32, 95% CI: 2.30-30.10), and hemodynamic instability (OR=6.9, 95% CI: 2.96-16.37) were associated with an increased risk of death. Patients treated with Kaletra, chloroquine, Itolizumab, or Jusvinza increased survival. Mortality risk in critically ill patients decreased from 80% to 25% with the use of Jusvinza. Conclusions: The clinical characterization performed demonstrates the effectiveness of the clinical protocols used in the country's intensive care units.

Variables asociadas a la severidad en pacientes con Covid-19 / Variables associated with severity in COVID-19 patients

En la COVID-19 un porcentaje de los enfermos desarrolla cuadros severos, con una elevada mortalidad, siendo necesario el estudio de sus características con el objetivo de frenar la progresión de la enfermedad. Se realizó un estudio retrospectivo en una cohorte de 150 pacientes adultos atendidos en el hospital Manuel Fajardo de Villa Clara, Cuba, en el período de marzo a junio de 2020. Se analizaron variables demográficas, clínicas, de laboratorio, gasométricas y radiológicas medidas al ingreso hospitalario; definiéndose dos grupos de pacientes según la evolución clínica: severos y no severos. Para la comparación de los grupos se realizó un análisis bivariado con el objetivo de determinar aquellas variables con asociación significativa a la severidad. Del total de pacientes, 26 (17,3%) evolucionaron a la severidad y 124 (83.7%), evolucionó satisfactoriamente. Los pacientes severos se caracterizaron por tener edad avanzada (media: 83 años) y presentar comorbilidades; siendo las más significativas: hipertensión arterial, diabetes mellitus, cardiopatía, enfermedad renal crónica y cáncer (p<0.0001). La polipnea y diarrea fueron las manifestaciones clínicas con mayor asociación a la severidad (p<0.0001), seguido por la fiebre (p=0.0157). La escala pronóstica quick SOFA mostró ser un instrumento útil para evaluar a los pacientes al ingreso. Las variables de laboratorio: neutrófilos, linfocitos, índice neutrófilos/linfocitos, hemoglobina. y lactato deshidrogenasa fueron las que mayor asociación tuvieron con la severidad (p<0.0001). Los leucocitos, lactato, dímero D, proteína C reactiva, glicemia y calcio también mostraron resultados significativos (p< 0.05). De las variables gasométricas, la presión y saturación arterial de oxígeno fueron las más significativamente asociadas a la severidad; así como la presencia de infiltrados o consolidación pulmonar en la radiografía de tórax (p <0.0001). El estudio permitió identificar variables al ingreso hospitalario, asociadas a progresión hacia formas severas de la enfermedad

In COVID-19, a percentage of patients develop severe disease, with high mortality, since has been necessary to study its characteristics to stop the progression of the disease. A retrospective study was carried out in a cohort of 150 adult patients attended at Manuel Fajardo Hospital in Villa Clara, Cuba, from March to June 2020. Demographic, clinical, laboratory, gasometric and radiological variables measured at hospital admission were analyzed, defining two groups of patients according to clinical evolution: severe and non-severe. For the comparison of the groups a bivariate analysis was performed, with the objective of determining those variables with a significant association to severity. Of the total number of patients, 26 (17.3%) evolved to severity and 124 (83.7%) evolved satisfactorily. Severe patients were characterized by advanced age (mean: 83 years) and comorbidities; the most significant being hypertension, diabetes mellitus, heart disease, chronic kidney disease and cancer (p< 0.0001). Polypnea and diarrhea were the clinical manifestations with the highest association with severity (p<0.0001), followed by fever (p=0.0157). The quick SOFA prognostic scale proved to be a useful instrument to evaluate patients at admission. Laboratory variables: neutrophils, lymphocytes, neutrophil/lymphocyte ratio, hemoglobin and lactate dehydrogenase were the most associated with severity (p<0.0001). Leukocytes, lactate, D-dimer, C-reactive protein, glycemia and calcium also showed significant results (p<0.05). Of the gasometric variables, arterial oxygen pressure and saturation were the most significantly associated with severity; as well as the presence of pulmonary infiltrates or consolidation in the chest X-ray (p<0.0001). The study allowed us to identify variables at hospital admission associated with progression to severe forms of the disease.

Equity and the Cuban National Health System's response to COVID-19.

Cuba's National Health System has managed to guarantee an effective and equitable response to COVID-19. Universal and free health coverage, based on primary care, follows the principle of equity and the greatest resources are allocated to areas of the lowest socioeconomic stratum (where higher risk is concentrated), followed by those of medium and high strata, in that order. This allowed for similar mortality rates in the three strata, and Cuban national mortality rate was one of the lowest in the Region of the Americas. Before the first case was identified in Cuba, a Plan for Coronavirus Prevention and Control was elaborated with multisectoral participation, and when the first case was confirmed the Temporary National Working Group to Fight COVID-19 was created as an advisory body of the government. The actions to face the pandemic began with preventive measures in the community, continued in the isolation centers and ended again in the community with actions of surveillance and follow up of recovered patients. Following the principle of territoriality, molecular diagnosis laboratories were created in the provinces that did not have one. Free medical care and treatment; the preparation of a single national intersectoral government plan; the use of particular strategies for research, diagnosis and case tracing; and the implementation of a universal protocol for disease prevention and treatment of confirmed cases made it possible to control the disease with a health equity perspective.

El Sistema Nacional de Salud de Cuba ha logrado garantizar una respuesta eficaz y con equidad en el enfrentamiento a la COVID-19. La cobertura de salud universal y gratuita, basada en la atención primaria, sigue el principio de equidad, por lo que los mayores recursos se asignan a los territorios del estrato socioeconómico más bajo, que concentra mayores riesgos de salud, seguidos de los de estratos medio y alto, en ese orden. Esto permitió tener tasas de letalidad similares en los tres estratos, y a nivel nacional la de Cuba es una de las tasas más bajas de la Región de las Américas. Antes de identificar el primer caso en Cuba, se elaboró el Plan para la Prevención y Control del Coronavirus, con participación multisectorial, y al confirmarse el primer caso se creó el Grupo Temporal de Trabajo para Enfrentar la COVID-19 como órgano asesor del Gobierno. Las acciones de enfrentamiento a la pandemia comienzan en la comunidad con medidas preventivas, continúan en los centros de aislamiento y terminan nuevamente en la comunidad, con acciones de vigilancia y acompañamiento a los enfermos recuperados. Siguiendo el principio de territorialidad, se crearon laboratorios de diagnóstico molecular en las provincias que no lo tenían. La atención médica y los tratamientos gratuitos; la preparación de un plan de gobierno intersectorial nacional único; la utilización de estrategias particulares para la pesquisa, diagnóstico y rastreo de casos; y la implementación de un protocolo universal para la prevención de la enfermedad y el tratamiento de los casos confirmados permitieron el control de la enfermedad con una perspectiva de equidad en salud.

O Sistema Nacional de Saúde de Cuba tem assegurado uma resposta eficaz e com equidade ao enfrentar a pandemia de COVID-19. A cobertura de saúde universal e gratuita baseada na atenção primária se pauta no princípio da equidade. Mais recursos são destinados às áreas de nível socioeconômico mais baixo que concentram risco de saúde maior e a seguir, nesta ordem, às áreas de nível socioeconômico médio e alto. Assim, a taxas de letalidade tem sido semelhante nos três níveis e a taxa nacional é uma das mais baixas da Região. Antes de o primeiro caso de COVID-19 ter sido detectado em Cuba, preparou-se o Plano para prevenção e controle do coronavírus com participação multissetorial. Quando o primeiro caso da doença foi confirmado, instituiu-se o Grupo de trabalho temporário para combater a COVID-19 como um órgão assessor do governo. As ações de combate à pandemia começam na comunidade com medidas preventivas, prosseguem nos centros de isolamento e retornam à comunidade com medidas de vigilância sanitária e o acompanhamento dos pacientes recuperados. E, seguindo o princípio de territorialidade, laboratórios de diagnóstico molecular foram instituídos nas províncias onde eles inexistiam. A atenção médica, o tratamento gratuito, a preparação de um plano de governo único intersetorial nacional, o emprego de estratégias próprias para pesquisa, diagnóstico e rastreio de casos e a implementação de um protocolo universal para prevenção da doença e tratamento dos casos confirmados possibilitaram controlar a doença de uma perspectiva de equidade em saúde.

Equity and the Cuban National Health System's response to COVID-19

[ABSTRACT]. Cuba’s National Health System has managed to guarantee an effective and equitable response to COVID-19. Universal and free health coverage, based on primary care, follows the principle of equity and the greatest resources are allocated to areas of the lowest socioeconomic stratum (where higher risk is concentrated), followed by those of medium and high strata, in that order. This allowed for similar mortality rates in the three strata, and Cuban national mortality rate was one of the lowest in the Region of the Americas. Before the first case was identified in Cuba, a Plan for Coronavirus Prevention and Control was elaborated with multisectoral participation, and when the first case was confirmed the Temporary National Working Group to Fight COVID-19 was created as an advisory body of the government. The actions to face the pandemic began with preventive measures in the community, continued in the isolation centers and ended again in the community with actions of surveillance and follow up of recovered patients. Following the principle of territoriality, molecular diagnosis laboratories were created in the provinces that did not have one. Free medical care and treatment; the preparation of a single national intersectoral government plan; the use of particular strategies for research, diagnosis and case tracing; and the implementation of a universal protocol for disease prevention and treatment of confirmed cases made it possible to control the disease with a health equity perspective.

[RESUMEN]. El Sistema Nacional de Salud de Cuba ha logrado garantizar una respuesta eficaz y con equidad en el enfrentamiento a la COVID-19. La cobertura de salud universal y gratuita, basada en la atención primaria, sigue el principio de equidad, por lo que los mayores recursos se asignan a los territorios del estrato socioeconómico más bajo, que concentra mayores riesgos de salud, seguidos de los de estratos medio y alto, en ese orden. Esto permitió tener tasas de letalidad similares en los tres estratos, y a nivel nacional la de Cuba es una de las tasas más bajas de la Región de las Américas. Antes de identificar el primer caso en Cuba, se elaboró el Plan para la Prevención y Control del Coronavirus, con participación multisectorial, y al confirmarse el primer caso se creó el Grupo Temporal de Trabajo para Enfrentar la COVID-19 como órgano asesor del Gobierno. Las acciones de enfrentamiento a la pandemia comienzan en la comunidad con medidas preventivas, continúan en los centros de aislamiento y terminan nuevamente en la comunidad, con acciones de vigilancia y acompañamiento a los enfermos recuperados. Siguiendo el principio de territorialidad, se crearon laboratorios de diagnóstico molecular en las provincias que no lo tenían. La atención médica y los tratamientos gratuitos; la preparación de un plan de gobierno intersectorial nacional único; la utilización de estrategias particulares para la pesquisa, diagnóstico y rastreo de casos; y la implementación de un protocolo universal para la prevención de la enfermedad y el tratamiento de los casos confirmados permitieron el control de la enfermedad con una perspectiva de equidad en salud.

[RESUMO]. O Sistema Nacional de Saúde de Cuba tem assegurado uma resposta eficaz e com equidade ao enfrentar a pandemia de COVID-19. A cobertura de saúde universal e gratuita baseada na atenção primária se pauta no princípio da equidade. Mais recursos são destinados às áreas de nível socioeconômico mais baixo que concentram risco de saúde maior e a seguir, nesta ordem, às áreas de nível socioeconômico médio e alto. Assim, a taxas de letalidade tem sido semelhante nos três níveis e a taxa nacional é uma das mais baixas da Região. Antes de o primeiro caso de COVID-19 ter sido detectado em Cuba, preparou-se o Plano para prevenção e controle do coronavírus com participação multissetorial. Quando o primeiro caso da doença foi confirmado, instituiu-se o Grupo de trabalho temporário para combater a COVID-19 como um órgão assessor do governo. As ações de combate à pandemia começam na comunidade com medidas preventi-vas, prosseguem nos centros de isolamento e retornam à comunidade com medidas de vigilância sanitária e o acompanhamento dos pacientes recuperados. E, seguindo o princípio de territorialidade, laboratórios de diagnóstico molecular foram instituídos nas províncias onde eles inexistiam. A atenção médica, o trata-mento gratuito, a preparação de um plano de governo único intersetorial nacional, o emprego de estratégias próprias para pesquisa, diagnóstico e rastreio de casos e a implementação de um protocolo universal para prevenção da doença e tratamento dos casos confirmados possibilitaram controlar a doença de uma per-spectiva de equidade em saúde.

Equity and the Cuban National Health System's response to COVID-19 / Equidad y respuesta del Sistema Nacional de Salud de Cuba ante la COVID-19 / Equidade e resposta do Sistema Nacional de Saúde de Cuba à pandemia de COVID-19

ABSTRACT Cuba's National Health System has managed to guarantee an effective and equitable response to COVID-19. Universal and free health coverage, based on primary care, follows the principle of equity and the greatest resources are allocated to areas of the lowest socioeconomic stratum (where higher risk is concentrated), followed by those of medium and high strata, in that order. This allowed for similar mortality rates in the three strata, and Cuban national mortality rate was one of the lowest in the Region of the Americas. Before the first case was identified in Cuba, a Plan for Coronavirus Prevention and Control was elaborated with multisectoral participation, and when the first case was confirmed the Temporary National Working Group to Fight COVID-19 was created as an advisory body of the government. The actions to face the pandemic began with preventive measures in the community, continued in the isolation centers and ended again in the community with actions of surveillance and follow up of recovered patients. Following the principle of territoriality, molecular diagnosis laboratories were created in the provinces that did not have one. Free medical care and treatment; the preparation of a single national intersectoral government plan; the use of particular strategies for research, diagnosis and case tracing; and the implementation of a universal protocol for disease prevention and treatment of confirmed cases made it possible to control the disease with a health equity perspective.

RESUMEN El Sistema Nacional de Salud de Cuba ha logrado garantizar una respuesta eficaz y con equidad en el enfrentamiento a la COVID-19. La cobertura de salud universal y gratuita, basada en la atención primaria, sigue el principio de equidad, por lo que los mayores recursos se asignan a los territorios del estrato socioeconómico más bajo, que concentra mayores riesgos de salud, seguidos de los de estratos medio y alto, en ese orden. Esto permitió tener tasas de letalidad similares en los tres estratos, y a nivel nacional la de Cuba es una de las tasas más bajas de la Región de las Américas. Antes de identificar el primer caso en Cuba, se elaboró el Plan para la Prevención y Control del Coronavirus, con participación multisectorial, y al confirmarse el primer caso se creó el Grupo Temporal de Trabajo para Enfrentar la COVID-19 como órgano asesor del Gobierno. Las acciones de enfrentamiento a la pandemia comienzan en la comunidad con medidas preventivas, continúan en los centros de aislamiento y terminan nuevamente en la comunidad, con acciones de vigilancia y acompañamiento a los enfermos recuperados. Siguiendo el principio de territorialidad, se crearon laboratorios de diagnóstico molecular en las provincias que no lo tenían. La atención médica y los tratamientos gratuitos; la preparación de un plan de gobierno intersectorial nacional único; la utilización de estrategias particulares para la pesquisa, diagnóstico y rastreo de casos; y la implementación de un protocolo universal para la prevención de la enfermedad y el tratamiento de los casos confirmados permitieron el control de la enfermedad con una perspectiva de equidad en salud.

RESUMO O Sistema Nacional de Saúde de Cuba tem assegurado uma resposta eficaz e com equidade ao enfrentar a pandemia de COVID-19. A cobertura de saúde universal e gratuita baseada na atenção primária se pauta no princípio da equidade. Mais recursos são destinados às áreas de nível socioeconômico mais baixo que concentram risco de saúde maior e a seguir, nesta ordem, às áreas de nível socioeconômico médio e alto. Assim, a taxas de letalidade tem sido semelhante nos três níveis e a taxa nacional é uma das mais baixas da Região. Antes de o primeiro caso de COVID-19 ter sido detectado em Cuba, preparou-se o Plano para prevenção e controle do coronavírus com participação multissetorial. Quando o primeiro caso da doença foi confirmado, instituiu-se o Grupo de trabalho temporário para combater a COVID-19 como um órgão assessor do governo. As ações de combate à pandemia começam na comunidade com medidas preventivas, prosseguem nos centros de isolamento e retornam à comunidade com medidas de vigilância sanitária e o acompanhamento dos pacientes recuperados. E, seguindo o princípio de territorialidade, laboratórios de diagnóstico molecular foram instituídos nas províncias onde eles inexistiam. A atenção médica, o tratamento gratuito, a preparação de um plano de governo único intersetorial nacional, o emprego de estratégias próprias para pesquisa, diagnóstico e rastreio de casos e a implementação de um protocolo universal para prevenção da doença e tratamento dos casos confirmados possibilitaram controlar a doença de uma perspectiva de equidade em saúde.

[Equity and the Cuban National Health System's response to COVID-19Equidade e resposta do Sistema Nacional de Saúde de Cuba à pandemia de COVID-19]. / Equidad y respuesta del Sistema Nacional de Salud de Cuba ante la COVID-19.

Cuba's National Health System has managed to guarantee an effective and equitable response to COVID-19. Universal and free health coverage, based on primary care, follows the principle of equity, and the greatest resources are allocated to areas of the lowest socioeconomic stratum (which concentrates the higher health risks), followed by those of medium and high strata, in that order. This allowed for similar mortality rates in the three strata, and Cuban national mortality rate was one of the lowest in the Region of the Americas. Before the first case was identified in Cuba, a Plan for Coronavirus Prevention and Control was elaborated with multisectoral participation, and when the first case was confirmed the Temporary Working Group to Fight COVID-19 was created as an advisory body of the government. The actions to face the pandemic began with preventive measures in the community, continued in the isolation centers and ended again in the community with actions of surveillance and follow up of recovered patients. Following the principle of territoriality, laboratories of molecular diagnosis were created in the provinces that did not have it. Free medical care and treatment; the preparation of a single national intersectoral government plan; the use of particular strategies for research, diagnosis and case tracing; and the implementation of a universal protocol for disease prevention and treatment of confirmed cases allowed to control the disease with a perspective of equity in health.

O Sistema Nacional de Saúde de Cuba tem assegurado uma resposta eficaz e com equidade ao enfrentar a pandemia de COVID-19. A cobertura de saúde universal e gratuita baseada na atenção primária se pauta no princípio da equidade. Mais recursos são destinados às áreas de nível socioeconômico mais baixo que concentram risco de saúde maior e a seguir, nesta ordem, às áreas de nível socioeconômico médio e alto. Assim, a taxas de letalidade tem sido semelhante nos três níveis e a taxa nacional é uma das mais baixas da Região. Antes de o primeiro caso de COVID-19 ter sido detectado em Cuba, preparou-se o Plano para prevenção e controle do coronavírus com participação multissetorial. Quando o primeiro caso da doença foi confirmado, instituiu-se o Grupo de trabalho temporário para combater a COVID-19 como um órgão assessor do governo. As ações de combate à pandemia começam na comunidade com medidas preventivas, prosseguem nos centros de isolamento e retornam à comunidade com medidas de vigilância sanitária e o acompanhamento dos pacientes recuperados. E, seguindo o princípio de territorialidade, laboratórios de diagnóstico molecular foram instituídos nas províncias onde eles inexistiam. A atenção médica, o tratamento gratuito, a preparação de um plano de governo único intersetorial nacional, o emprego de estratégias próprias para pesquisa, diagnóstico e rastreio de casos e a implementação de um protocolo universal para prevenção da doença e tratamento dos casos confirmados possibilitaram controlar a doença de uma perspectiva de equidade em saúde.

Equidad y respuesta del Sistema Nacional de Salud de Cuba ante la COVID-19

[RESUMEN]. El Sistema Nacional de Salud de Cuba ha logrado garantizar una respuesta eficaz y con equidad en el enfrentamiento a la COVID-19. La cobertura de salud universal y gratuita, basada en la atención primaria, sigue el principio de equidad, por lo que los mayores recursos se asignan a los territorios del estrato socioeconómico más bajo, que concentra mayores riesgos de salud, seguidos de los de estratos medio y alto, en ese orden. Esto permitió tener tasas de letalidad similares en los tres estratos, y a nivel nacional la de Cuba es una de las tasas más bajas de la Región de las Américas. Antes de identificar el primer caso en Cuba, se elaboró el Plan para la Prevención y Control del Coronavirus, con participación multisectorial, y al confirmarse el primer caso se creó el Grupo Temporal de Trabajo para Enfrentar la COVID-19 como órgano asesor del Gobierno. Las acciones de enfrentamiento a la pandemia comienzan en la comunidad con medidas preventivas, continúan en los centros de aislamiento y terminan nuevamente en la comunidad, con acciones de vigilancia y acompañamiento a los enfermos recuperados. Siguiendo el principio de territorialidad, se crearon laboratorios de diagnóstico molecular en las provincias que no lo tenían. La atención médica y los tratamientos gratuitos; la preparación de un plan de gobierno intersectorial nacional único; la utilización de estrategias particulares para la pesquisa, diagnóstico y rastreo de casos; y la implementación de un protocolo universal para la prevención de la enfermedad y el tratamiento de los casos confirmados permitieron el control de la enfermedad con una perspectiva de equidad en salud.

[ABSTRACT]. Cuba's National Health System has managed to guarantee an effective and equitable response to COVID-19. Universal and free health coverage, based on primary care, follows the principle of equity, and the greatest resources are allocated to areas of the lowest socioeconomic stratum (which concentrates the higher health risks), followed by those of medium and high strata, in that order. This allowed for similar mortality rates in the three strata, and Cuban national mortality rate was one of the lowest in the Region of the Americas. Before the first case was identified in Cuba, a Plan for Coronavirus Prevention and Control was elaborated with multisectoral participation, and when the first case was confirmed the Temporary Working Group to Fight COVID-19 was created as an advisory body of the government. The actions to face the pandemic began with preventive measures in the community, continued in the isolation centers and ended again in the community with actions of surveillance and follow up of recovered patients. Following the principle of territoriality, laboratories of molecular diagnosis were created in the provinces that did not have it. Free medical care and treatment; the preparation of a single national intersectoral government plan; the use of particular strategies for research, diagnosis and case tracing; and the implementation of a universal protocol for disease prevention and treatment of confirmed cases allowed to control the disease with a perspective of equity in health.

[RESUMO]. O Sistema Nacional de Saúde de Cuba tem assegurado uma resposta eficaz e com equidade ao enfrentar a pandemia de COVID-19. A cobertura de saúde universal e gratuita baseada na atenção primária se pauta no princípio da equidade. Mais recursos são destinados às áreas de nível socioeconômico mais baixo que concentram risco de saúde maior e a seguir, nesta ordem, às áreas de nível socioeconômico médio e alto. Assim, a taxas de letalidade tem sido semelhante nos três níveis e a taxa nacional é uma das mais baixas da Região. Antes de o primeiro caso de COVID-19 ter sido detectado em Cuba, preparou-se o Plano para prevenção e controle do coronavírus com participação multissetorial. Quando o primeiro caso da doença foi confirmado, instituiu-se o Grupo de trabalho temporário para combater a COVID-19 como um órgão assessor do governo. As ações de combate à pandemia começam na comunidade com medidas preventivas, prosseguem nos centros de isolamento e retornam à comunidade com medidas de vigilância sanitária e o acompanhamento dos pacientes recuperados. E, seguindo o princípio de territorialidade, laboratórios de diagnóstico molecular foram instituídos nas províncias onde eles inexistiam. A atenção médica, o tratamento gratuito, a preparação de um plano de governo único intersetorial nacional, o emprego de estratégias próprias para pesquisa, diagnóstico e rastreio de casos e a implementação de um protocolo universal para prevenção da doença e tratamento dos casos confirmados possibilitaram controlar a doença de uma perspectiva de equidade em saúde.

Sostenibilidad de una estrategia cubana de empoderamiento comunitario para la prevención del dengue desde la perspectiva de sus actores claves / Sustainability of a Cuban community empowerment strategy for dengue fever prevention from the perspective of its key actors

Introducción: Las revisiones sistemáticas sobre intervenciones para la prevención del dengue señalan que existe poca evidencia sobre la sostenibilidad de estrategias participativas. Una estrategia cubana basada en el empoderamiento de la comunidad se implementó entre los años 2004-2007 y constó de cuatro componentes: organización, capacitación, trabajo comunitario, y la vigilancia de riesgos y comportamientos. Objetivo: Evaluar la percepción de sostenibilidad de la estrategia de empoderamiento comunitario para la prevención del dengue desde la perspectiva de los actores claves de su implementación. Métodos: Se realizó un estudio descriptivo de corte cualitativo anidado en el estudio experimental, de abril a septiembre de 2011. La sostenibilidad fue entendida como el uso continuado de los componentes de la estrategia y la ejecución de actividades a más de 3 años de concluida la etapa de implementación y evaluación, y el financiamiento externo de la investigación. Se realizaron entrevistas en profundidad a actores claves con un rol significativo durante las etapas de diseño e implementación. La información verbal se clasificó en categorías de análisis inductivas que emergieron de la lectura reiterada de los datos, y posteriormente se reclasificó y contrastó con indicadores operacionales de sostenibilidad de intervenciones de salud. Resultados: Los entrevistados identificaron transformaciones generadas por la estrategia (ejemplo: incremento de capacidades locales, crecimiento personal/profesional, nuevos estilos y organización del trabajo) a nivel de municipio, consejo popular y circunscripción. Desde la percepción la estrategia fue sostenible (91 referencias) y se aportaron nuevos elementos que enriquecen los indicadores operacionales de sostenibilidad utilizados, los cuales reconocen los beneficios de salud, y otros efectos directos a partir de la concepción de empoderamiento asumida por la propuesta. La construcción de capacidades fue valorada por los actores salud como el fortalecimiento de las competencias de los médicos y enfermeras de la familia, para guiar procesos participativos en las comunidades. Conclusiones: La perspectiva de los actores enriqueció el análisis de la sostenibilidad de la estrategia y reconoce la importancia del proceso de construcción de capacidades para empoderamiento desde la educación popular promovida durante la implementación para el mantenimiento de los resultados y su relación con los efectos informados por los actores(AU)

Introduction: Systematic reviews about dengue fever prevention interventions show that there is little evidence of the sustainability of participatory strategies. A Cuban community empowerment strategy was implemented between the years 2004 and 2007. It consisted of four components: organization, training, community work, and surveillance of risks and behavior. Objective: Evaluate the perception about sustainability of the community empowerment strategy for dengue fever prevention from the perspective of the key actors of its implementation. Methods: A nested descriptive qualitative experimental study was conducted from April to September 2011. Sustainability was understood as the continued use of the components of the strategy, the conduct of activities more than 3 years after completion of the implementation and evaluation stage, and external funding for the research. In-depth interviews were held with key actors playing a significant role during the stages of design and implementation. The information obtained was classified into inductive analysis categories emerging from the reiterated reading of the data, and was then reclassified and contrasted with operational sustainability indicators for health interventions. Results: Interviewees identified a number of changes brought about by the strategy, e.g. an increase in local capacities, personal / professional growth, new work styles and organization at the municipal, people's council and constituency levels. The strategy was perceived as sustainable (91 references), and new data were provided which enrich the operational sustainability indicators used and recognize the benefits to health care and other direct effects of the concept of empowerment underlying the proposal. The building of capacities was evaluated by health actors as the strengthening of family doctors' and nurses' competencies to lead participatory processes in the community. Conclusions: The views contributed by actors enriched the analysis about the sustainability of the strategy and recognized the importance of capacity building for empowerment based on community education, as fostered during the implementation stage, for the maintenance of results and their relationship to the effects reported by actors(AU)

Intervención Educativa para mejorar la calidad del Diagnóstico de la Malaria en la red de Laboratorios de Luanda, República de Angola / Educative Intervention to improve quality of malaria diagnosisin the network of laboratories from Luanda, Republic of Angola

Introducción: la malaria continúa siendo uno de los más importantes problemas de salud pública a nivel mundial que afecta con énfasis al continente africano y a Angola.Objetivos: evaluar el nivel de conocimientos teóricos y prácticos en el diagnóstico de la malaria de un grupo de técnicos en Luanda antes y después de una intervención educativa. Material y Métodos: entre abril y julio de 2013 se realizó un estudio experimental con grupo de control en 120 técnicos de la red de salud de Luanda; se hicieron dos evaluaciones teóricas y prácticas: una, al comienzo y otra, 3 meses después de una intervención educativa. Se incluyó un grupo adicional de control de 120 técnicos que fueron evaluados al mismo tiempo y en quienes no se hizo intervención. Los entrenamientos fueron de 10 días cumplimentando un programa de clases prácticas y teóricas. Resultados: después de los entrenamientos en el grupo de Intervención, las notas ascendieron tras la segunda evaluación; mientras que en el grupo de control las calificaciones se mantuvieron sin cambios. Se observó que en el grupo de Intervención la probabilidad de estar desaprobado fue 129 veces mayor en la evaluación inicial para las pruebas teóricas y 108 veces mayor en los exámenes prácticos. Finalmente fueron identificados los principales aspectos en que fallaron los técnicos evaluados en los grupos de intervención y control. Conclusiones: se demostró una mejoría en los conocimientos teóricos y prácticos de los técnicos de laboratorio dedicados al diagnóstico de la malaria después de la intervención educativa(AU)

Introduction: the malaria still is one of the most important public health problems worldwide, specially the Africa as well as in Angola. Objectives: the aim was to evaluate the level of theoretical and practical knowledge in malaria diagnosis of a large group of technicians in Luanda before and after of an educational intervention.Material and Methods: between April and July of 2013 an experimental study with a control group was carried out in 120 technicians from Luanda. The evaluations were applied previous and after (three months) of an educational intervention. Another additional group of 120 technicians (control group) were evaluated too at the same period of time, but intervention was not made on them. Trainings were made during 10 days by completing a program with practical and theoretical classes.Results:after the trainings in the intervention group the scores increased in the theoretical and practical evaluations; while in the control group the scores of evaluations did not change after final evaluations. In the Intervention group the rate of disapproval was 129 times higher in the first evaluation than in final evaluation and this odd was 108 times higher in practical evaluations. Finally, the main topics with errors were identified in the evaluations from the beginning in the intervention and the control groups. Conclusions: in this study carried out in Luanda, Angola, an improvement of the evaluations was showed in theoretical and practical knowledge of the technicians after intervention in the network of laboratories of the capital province of the country(AU)

Comparación de los métodos de gota gruesa y tiras de diagnóstico rápido para el diagnóstico de la malaria en Luanda, Angola / Comparison of thick blood smear and rapid test methods for malaria diagnosis in Luanda, Angola

Introducción: a pesar de que se ha logrado reducir la morbilidad y la mortalidad de la malaria en África, esta constituye aún un importante problema de salud en Angola, y su capital, Luanda. Objetivo: comparar la ejecución de la microscopía contra un método de tiras de diagnóstico rápido para el diagnóstico de la malaria. Material y Métodos: se llevó a cabo un estudio de corte transversal para evaluar la precisión de una prueba rápida para el diagnóstico del paludismo. Entre diciembre de 2013 y marzo de 2014; se seleccionaron aleatoriamente 1 000 muestras de sangre de pacientes quienes acudieron a los laboratorios por diagnóstico sospechoso de malaria, las que fueron analizadas por gota gruesa, y una prueba de diagnóstico rápido (SD Bioline Malaria AntigenPf/Pv®). Se evaluó la concordancia, la validez y la seguridad de ambos métodos, y para ello las gotas gruesas, fueron consideradas como la "prueba de oro". Resultados: se obtuvo una mayor frecuencia de positividad con las TDR que con las gotas gruesas en dos de los centros de salud (p<0,05). Al comparar los valores de concordancia, validez y seguridad entre los métodos empleados para el diagnóstico de la malaria se obtuvieron valores de concordancia superiores con la gota gruesa que con las TDR. De la misma forma, la especificidad y los valores predictivos de los positivos también fueron superiores con las gotas gruesas (p<0,01). Conclusiones: este estudio permite considerar esta técnica de diagnóstico rápido como un método adecuado y sensible para diagnosticar infecciones por P. falciparum en Luanda(AU)

Introduction: despite of National programs for control have reduced the morbidity and mortality because of malaria in Africa, this parasitic disease is still an important public health problem in the continent, in the Republic of Angola, and its capital Luanda.Objective: to compare the skills of technicians on malaria microscopy and to compare the microscopy against a rapid diagnostic test (RTD) in health centers from Luanda. Material and Methods: among December 2013 y march 2014, one thousand samples were randomly selected from patients visiting laboratories because of suspected diagnosis of malaria. These samples were observed by 20 technicians in 10 health centers from Luanda. A blood sample was taken by every person in order to be examined by thick smear (TS) and a RTD (SD Bioline Malaria Antigen Pf/Pv®). The concordance, the validity, and safety of both methods were evaluated, and the gold standard was defined by thick smears observed by four malaria expert technicians.Results: the frequency of positivity obtained with RTD was higher than with TSin health centers from Kassequel, Samba, and Km 12 (p<0.05). The comparison of concordance, validity, and safety between used methods for the diagnosis of malaria showed concordance values with TS higher than RTD. The specificity and predictive values for positives were upper with TS than RTD (p<0,01). Conclusions: this study showed the RTDBioline Malaria Ag f/Pv®, is an adequate and sensible method for the diagnosis of P. falciparum infections in Luanda(AU)