Prevalence of intestinal parasitism in preschool and school children in Colombia: Systematic review and meta-analysis.

OBJECTIVE: Intestinal parasitic infections (IPIs) are a public health challenge in developing countries such as Colombia, causing anaemia and delayed growth and development in children. We aimed to estimate the geographical and prevalence trend of IPIs in the last 30 years in school and preschool children in Colombia. METHODS: We conducted a systematic review and meta-analysis. We identified potential manuscripts through PubMed, EMBASE, Web of Science, LILACS, Scielo and Google Scholar on the IPIs prevalence in school and preschool children in Colombia. Articles included in the qualitative analysis were published between 1990 and 2020 in English or Spanish and met the inclusion criteria. Subsequently, a random-effects meta-analysis, a meta-regression and a trend analysis were performed. RESULTS: We identified 2292 articles; 109 were included in the qualitative review, and 79 articles were included in the meta-analysis. The estimated IPI prevalence was 55% (95% CI: 48-63). By age group, the prevalence in preschool children was 37% (95% CI: 26-49) and 66% (95% CI: 52-78) in schoolchildren. The prevalence by region was heterogeneous, with the Amazon being the highest (69%) and the Santanderes the lowest (28%). In the last 20 years, the prevalence of helminthiasis has decreased (from 64.66% in 1990-1995 to 22.09% in 2016-2020). CONCLUSION: The prevalence of IPIs is high (>30%) in three of the seven regions in Colombia. Biannual administration of mass deworming in schoolchildren is recommended in the Amazon region. Public policies aiming to control IPIs should be reinforced. Further prevalence studies should include Cesar, Guaviare, Vichada and Vaupés, where the epidemiology of IPIs is unknown. SUSTAINABLE DEVELOPMENT GOALS: Good health and wellbeing, clean water and sanitation, sustainable cities and communities.

Molecular surveillance for anti-malarial drug resistance and genetic diversity of Plasmodium falciparum after chloroquine and sulfadoxine-pyrimethamine withdrawal in Quibdo, Colombia, 2018.

BACKGROUND: Resistance to anti-malarial drugs is associated with polymorphisms in target genes and surveillance for these molecular markers is important to detect the emergence of mutations associated with drug resistance and signal recovering sensitivity to anti-malarials previously used. METHODS: The presence of polymorphisms in genes associated with Plasmodium falciparum resistance to chloroquine and sulfadoxine-pyrimethamine was evaluated by Sanger sequencing, in 85 P. falciparum day of enrollment samples from a therapeutic efficacy study of artemether-lumefantrine conducted in 2018-2019 in Quibdo, Colombia. Samples were genotyped to assess mutations in pfcrt (codons 72-76), pfdhfr (codons 51, 59, 108, and 164), and pfdhps genes (codons 436, 437, 540, and 581). Further, the genetic diversity of infections using seven neutral microsatellites (NMSs) (C2M34, C3M69, Poly α, TA1, TA109, 2490, and PfPK2) was assessed. RESULTS: All isolates carried mutant alleles for pfcrt (K76T and N75E), and for pfdhfr (N51I and S108N), while for pfdhps, mutations were observed only for codon A437G (32/73, 43.8%). Fifty samples (58.8%) showed a complete neutral microsatellites (NMS) profile. The low mean number of alleles (2 ± 0.57) per locus and mean expected heterozygosity (0.17 ± 0.03) showed a reduced genetic diversity. NMS multilocus genotypes (MMG) were built and nine MMG were identified. CONCLUSIONS: Overall, these findings confirm the fixation of chloroquine and pyrimethamine-resistant alleles already described in the literature, implying that these drugs are not currently appropriate for use in Colombia. In contrast, mutations in the pfdhps gene were only observed at codon 437, an indication that full resistance to sulfadoxine has not been achieved in Choco. MMGs found matched the clonal lineage E variant 1 previously reported in northwestern Colombia.

Opportunity cost and COVID-19: A perspective from health economics.

The substantial increase in demand for medical care in intensive care units (ICUs) caused by the recent appearance of coronavirus disease 2019 (COVID-19) has placed severe pressure on hospital beds. Although countries have intensified efforts to contain or delay the spread of COVID-19, they must prepare to cope with the growing demand for critical care inpatient beds or risk being overwhelmed by the pandemic. The subject of this paper is the COVID-19 pandemic and the opportunity cost from the perspective of health economics using the supply and demand model of hospital bed days in ICUs. In this context, it has been seen that there is an excess demand for hospital beds that exceeds the supply of bed days provided by the health system, generating opportunity costs for patients who cannot be admitted to ICUs because beds are not available. Policymakers must take into account the notion of opportunity cost to ensure that scarce resources are used efficiently because patients with and without COVID-19 will be competing for the same ICU resources.

Exploring the latency period in Chagas disease: duration and determinants in a cohort from Colombia.

BACKGROUND: Chagas disease has a varying latency period, the time between infection and onset of cardiac symptoms, due to multiple factors. This study seeks to identify and understand these factors to enhance our knowledge of the disease. METHODS: A retrospective follow-up study was conducted in Colombia on patients with indeterminate chronic Chagas disease. Medical files were examined to evaluate the disease latency time using time ratios (TRs) and the AFT Weibull model. RESULTS: The study followed 578 patients, of whom 309 (53.5%) developed cardiac disease, with a median latency period of 18.5 (95% CI 16 to 20) y for the cohort. Those with the TcISyl genotype (TR 0.72; 95% CI 0.61 to 0.80), individuals who lived 5-15 y (TR 0.80; 95% CI 0.67 to 0.95), 15-30 y (TR 0.63; 95% CI 0.53 to 0.74) or >30 y (vs 5 y) in areas with high disease prevalence had shorter latency periods. On the other hand, undergoing treatment increased the latency period (TR: 1.74; 95% CI 1.52 to 1.87). CONCLUSIONS: The latency period of Chagas disease was found to be independently related to male gender, receipt of etiological treatment, length of time spent in an endemic area and the TcISyl genotype. The implications of these findings are discussed.

Changes in the endemic-epidemic pattern of malaria in Colombia, 1978-2021.

BACKGROUND: Malaria is a major global public health issue with varying epidemiologies across countries. In Colombia, it is a priority endemic-epidemic event included in the national public health policy. However, evidence demonstrating nationwide variations in the disease behavior is limited. This study aimed to analyze changes in the levels and distribution of endemic-epidemic malaria transmission in the eco-epidemiological regions of Colombia from 1978 to 1999 and 2000 to 2021. METHODS: We conducted a comprehensive time-series study using official secondary data on malaria-associated morbidity and mortality in Colombia from 1978 to 2021. Temporal-spatial and population variables were analyzed, and the absolute and relative frequency measures of general and regional morbidity and mortality were estimated. RESULTS: We observed an 18% reduction in malaria endemic cases between the two study periods. The frequency and severity of the epidemic transmission of malaria varied less and were comparable across both periods. A shift was observed in the frequency of parasitic infections, with a tendency to match and increase infections by Plasmodium falciparum. The risk of malaria transmission varied significantly among the eco-epidemiological regions during both study periods. This study demonstrated a sustained decrease of 78% in malarial mortality. CONCLUSIONS: Although the endemic components of malaria decreased slightly between the two study periods, the epidemic pattern persisted. There were significant variations in the risk of transmission across the different eco-epidemiological regions. These findings underscore the importance of targeted public health interventions in reducing malarial morbidity and mortality rates in Colombia.

Addressing Chagas disease from a One Health perspective: risk factors, lessons learned and prevention of oral transmission outbreaks in Colombia.

Background: Chagas disease (CD) is transmitted by vectors but can also be transmitted orally through contaminated food, drinks, or meat. The One Health perspective aims to understand the complex interaction between human, animal, and environmental health in controlling disease. This study analyzed risk factors and drew lessons from past outbreaks of orally transmitted CD to develop effective preventive strategies. Methods: A simultaneous mixed methods study was conducted. The study consisted of two phases: an ecological epidemiological analysis at the municipal level using secondary data spanning from 1992 to 2023, and semistructured interviews with health providers and policymakers at the national level in Colombia. The results from both phases were triangulated to gain a comprehensive understanding of the topic. Results: A total of 64 outbreaks, infecting 302 individuals, were reported. Most of these outbreaks (89.2%) were classified as family-related, and they occurred most frequently during the months of April to June (46.6%). It is worth noting that a significant number of these outbreaks took place in municipalities that lacked vector control plans. Risk factors for oral transmission included the location of food preparation, poor housing quality, food preparation water source, the presence of vectors/marsupials, forest type, and climatic variables. Interviews conducted emphasized the importance of implementing outbreak plans and providing staff training to effectively address the issue. Conclusion: A One Health approach strengthening prevention, surveillance, case management and cross-sectoral collaboration is needed to control outbreaks and reduce transmission in Colombia. Preparedness plans and education of health professionals are also important. This study identified modifiable risk factors to guide public health interventions.

First report of an acute case of chagas disease in the municipality of Miraflores, Guaviare, Colombia. / Primer caso agudo de enfermedad de Chagas en el municipio de Miraflores, Guaviare, Colombia.

We present a case of acute phase Chagas disease in a 40-year-old male patient from Vereda Buenos Aires, Municipality of Miraflores, Department of Guaviare. The patient attended the emergency department with fever, headache, asthenia, adynamia and dysuria. The blood smear and urinalysis were positive for symptomatic urinary tract infection, but negative for malaria. Five days later the diagnosis of acute phase Chagas disease was confirmed after a positive result for Trypanosoma cruzi. The patient was treated with nifurtimox and benznidazole, his contacts and risk areas were investigated, an active entomological community and institutional search was carried out, as well as in the reservoirs, finally, laboratory surveillance for possible cases of infection in the community was conducted. Five cases with similar symptoms were identified, but parasitological tests were negative. Health education measures were implemented to prevent the spread of the disease.

Se presenta un caso de enfermedad de Chagas en fase aguda en un paciente masculino de 40 años, procedente de la Vereda Buenos Aires, Municipio de Miraflores, Departamento del Guaviare. El paciente acudió a urgencias con fiebre, cefalea, astenia, adinamia y disuria. Se realizó un frotis de sangre y un análisis de orina, con resultados positivos para infección urinaria sintomática, pero negativos para malaria. Cinco días más tarde se confirmó el diagnóstico de enfermedad de Chagas en fase aguda tras recibir un resultado positivo para Trypanosoma cruzi. El paciente recibió tratamiento con nifurtimox y benznidazol, y se llevó a cabo una investigación de contactos y zonas de riesgo, búsqueda activa comunitaria e institucional, entomológica y de reservorios, y una vigilancia de laboratorio para detectar posibles casos de infección en la comunidad. Se identificaron cinco casos con síntomas similares, pero las pruebas parasitológicas fueron negativas. Se aplicaron medidas de educación sanitaria para prevenir la propagación de la enfermedad.

Epidemiological evolution and historical anti-malarial control initiatives in Colombia, 1848-2019.

The evolution of epidemiological transmission and the control measures implemented in Colombia have been the result of complex global and regional economic and political processes that occurred at different historical moments, since the dawn of the country's republican life. The development of economic activities for the production, exploitation and export of agricultural products, minerals and raw materials demanded in the international market, favored the necessary conditions for the emergence, expansion, resurgence and persistence of the endemic epidemic of malaria in the different stages studied. A common and fundamental element in the different defined historical moments was the importance given to malaria as an economic problem due to the negative externalities it imposed on the labor force. In addition, due to the role it played as a barrier that limited the exploitation of natural resources and raw materials of interest; as well as the impact that it caused to the flow and commercial exchange. The previous situation was framed with the growth, consolidation and geostrategic expansion of the United States, as the main commercial partner of the region, and its interest in the exploitation of resources and raw materials, cheap labor, the need to create new markets, which coincided with the goals of modernization and economic strengthening of Colombia. Taking into account different relevant milestones that occurred in the 1848-2019 period, the following stages were defined: Epidemiological emergence and re-emergence of tropical fevers in places of economic exploitation, 1848-1899;Emergence of a new paradigm, control in enclaves of economic interest, ports and cities, 1900-1949;Control to eradication, intensified control-eradication, prevention and control, 1950-1999;Prevention, control and elimination of malaria, 2000-2019. Historically, antimalarial control initiatives in the country have been directed, restricted and prioritized in places of political and economic importance. The technical-scientific intervention measures implemented in the different stages studied have been uncritically replicated without adapting to the epidemiological scenarios existing in the country. Finally, the antimalarial control measures implemented in Colombia have been imported and adopted from international health initiatives as a result of commitments and obligations acquired in the global commercial context.

Malaria in the eco-epidemiological region of the Colombian Caribbean, 1960-2019. / Malaria en la región eco-epidemiológica del Caribe Colombiano, 1960-2019.

OBJECTIVES.: Motivation for the study: the information available on the epidemiology of malaria in the Colombian Caribbean region is incomplete, poorly systematized and its dissemination is limited. This has led to a lack of knowledge of its magnitude and a low perception of its importance as a public health problem. Main findings: the behavior of malaria is endemic-epidemic, with low to very low transmission, focused and with irregular outbreaks. Plasmodium vivax infections predominate. Implications: the results of this study contribute to improve evidence-based decision making for the implementation of malaria eradication plans. Malaria has a heterogeneous and variable behavior among Colombian regions. In order to establish its epidemiological behavior in the Colombian Caribbean region between 1960 and 2019, we carried out an observational, descriptive and retrospective study based on records from the Ministry of Health and other secondary sources. We defined epidemiological variables and used measures of frequency and central tendency. A total of 155,096 cases were registered. The decades with the highest number of cases were 1990-1999 (20.5%) and 1980-1989 (18.9%). The average number of cases per decade was 25,849.3. The highest parasite rates were recorded in 1970 (3.3 per 1000 population) and 1981 (3.9 per 1000 population). Plasmodium vivax was the most frequent species and most of the burden by age group was found in people under 29 years of age, between 2010-2019. Malaria showed an endemic-epidemic pattern of low and very low transmission intensity, with a decreasing trend.

OBJETIVOS.: Motivación para realizar el estudio: la información disponible sobre la epidemiología de la malaria en la región del Caribe colombiano está incompleta, poco sistematizada y su divulgación es limitada. Esto ha generado un desconocimiento en su magnitud y una baja percepción de su importancia como problema de salud pública. Principales hallazgos: el comportamiento de la malaria es endemo-epidémico, de baja a muy baja transmisión, focalizado y con aparición de brotes irregulares. Predominan las infecciones por Plasmodium vivax. Implicancias: los resultados este estudio contribuyen a mejorar la toma de decisiones basadas en evidencia, para la ejecución de planes de eliminación de la malaria. La malaria en Colombia tiene un comportamiento heterogéneo y variable, entre las regiones. Para establecer su comportamiento epidemiológico en la región del Caribe colombiano entre 1960 y 2019 se realizó un estudio observacional, descriptivo y retrospectivo a partir de registros del Ministerio de Salud y otras fuentes secundarias. Se definieron variables epidemiológicas y se elaboraron medidas de frecuencia y tendencia central. Se registraron 155 096 casos. Las décadas con mayor número de casos fueron 1990-1999 (20,5%) y 1980-1989 (18,9%). El promedio de casos por década fue de 25 849,3. Los índices parasitarios más elevados se registraron en 1970 (3,3 por 1000 habitantes) y 1981 (3,9 por 1000 habitantes). La especie Plasmodium vivax fue la más frecuente y la mayoría de la carga por grupos de edad se registró en menores de 29 años, entre 2010-2019. La malaria presentó un patrón endemo-epidémico de baja y muy baja intensidad de transmisión, con una tendencia al descenso.

A Retrospective Review on Severe Malaria in Colombia, 2007-2020.

BACKGROUND: Knowledge of severe malaria (SM) or complicated malaria is insufficient in all its components. The least known type is the one associated with Plasmodium vivax, compared to that caused by P. falciparum. The aim of this study was to provide a general overview of epidemiological information about the burden of SM, obtained from the National Public Health Surveillance System (SIVIGILA) for the period 2007-2020 in Colombia. METHODS: A descriptive, retrospective, and cross-sectional study of secondary information was performed via SIVIGILA. RESULTS: There were 9881 SM cases among 1,060,950 total malaria cases in Colombia in 2007-2020: 9.31 SM cases per 1000 malaria cases. During this period, there were 7145 SM cases due to the following species: Plasmodium vivax, 57.6%; P. falciparum, 38.6%; severe mixed malaria, 3.2%; and P. malariae, 0.6%. The most compromised organ systems are the hematological system (54.9%), the liver (9.1%), the kidneys (4.2%), the lungs (1.9%) and the brain (1.6%). CONCLUSIONS: There has been a reduction in malaria incidence in Colombia in the last 10-15 years, but there has also been a strong increase in SM incidence. We suggest emphasizing the prevention of the onset of severe malaria, with the early and accurate diagnosis of plasmodial infection.

Malaria epidemics in Colombia, 1970-2019.

BACKGROUND: Malaria has unstable transmission in Colombia and has variable endemic-epidemic patterns. This study describes the epidemiological characteristics of malaria epidemics registered in Colombia from 1970-2019. METHODS: Data from 1979-2019 were collected from the National Public Health Surveillance System. The data was tabulated and pertinent descriptive analyses were carried out. RESULTS: Fifteen malaria outbreaks and approximately five-year-long epidemic cycles were observed in Colombia during the study period. CONCLUSIONS: Malaria epidemics in Colombia present a five-yearly transmission pattern, mainly due to the increased vulnerability produced by seasonal population migrations in receptive areas with active transmission.

Comparison of 1-year healthcare resource utilization and related costs for patients with heart failure in the Chagas and non-Chagas matched cohorts.

Background: Chagas disease is one of the leading causes of heart failure (HF) in Latin Americans, and there are limited data available that examine related costs of care for patients with HF. This study aimed to compare healthcare resource utilization and related costs for patients with HF, with and without Chagas disease. Methods: A prospective matched-cohort study comparing the healthcare costs for patients with HF with Chagas disease and care costs for patients with HF without Chagas disease was conducted between January 2019 and December 2019. Only direct costs have been estimated, including hospitalization costs, medications and other cardiovascular interventions, and clinical and laboratory follow-up for up to 1 year. Results: A total of 80 patients with chronic HF were included in the study. Of the 80 patients, 40 patients in the Chagas cohort and 40 patients in the non-Chagas cohort were matched for age, insurer and sex. From a social security system perspective, the total costs for the two cohorts during the study period were U$970,136. Specifically, the healthcare costs for the Chagas cohort were greater than the total healthcare costs for the non-Chagas group (U$511,931 versus U$458,205; p = 0.6183) Most costs were associated with hospitalizations (65.5% versus 59.6%), with averages of U$12,798.5 and U$11,455.1 per person in the Chagas and non-Chagas groups, respectively. In both the Chagas (51.6%) and non-Chagas cohorts (54.5%), causes of readmission unrelated to HF outweighed causes of readmission related to HF. High incidences of hospital admissions were observed during the rainy (cold) season for both cohorts. Conclusions: Over a 12-month follow-up period, patients with chronic HF and Chagas consume as many healthcare resources as those with chronic HF and without Chagas. These data highlight the considerable and growing economic burden of HF on the Colombian health system.

Risk factors and spatial analysis for domiciliary infestation with the Chagas disease vector Triatoma venosa in Colombia.

Background: In Colombia, communities living in the Andean region are the most affected by Chagas disease due to the presence of the main vectors, the environmental and risk factors associated with house infestation. Triatoma venosa is classified as a secondary vector that is frequently found in the departments of Boyaca and Cundinamarca, but epidemiological information and its association with risk factors in domestic and peridomestic areas is unknown. The study aimed to evaluate housing and environmental characteristics associated with domestic and peridomestic infestation by T. venosa and a risk map was estimated. Methods: A cross-sectional study was conducted in municipalities of Boyaca and Cundinamarca, Colombia. From March to July 2015, triatomine infestation screening surveys were conducted in 155 households. Multivariate analysis was performed to evaluate associations with the infestation and ecological niche modeling was estimated using environmental variables. Results: No statistical association was found with any of the housing variables in the adjusted multivariate analysis. However, in raw relationship infestation was associated with bushes < 10 m (OR = 3; 95% CI: 1.3-7.3) and higher temperature p value < 0.05. The developed final risk map pointed to 12 municipalities with no previous report of the disease, which should be sampled for the presence of T. venosa. Conclusion: This study highlights the relationship between environmental factors and T. venosa in Colombia and the importance of modeling tools to improve mapping efforts. Additional studies are needed to verify the association with bushes and higher temperatures and to verify infestation in predicted risk area with no previous report of the species.

The malaria eradication campaign in Colombia, 1959-1979 / La campaña de erradicación de la malaria en Colombia, 1959-1979

Introduction: In the mid-fifties, Colombia adopted and implemented the Malaria Eradication Campaign (MEC), which has not been evaluated yet in the country. Objective: To evaluate the results achieved during the attack and consolidation phases of the MEC regarding malaria transmission in Colombia between 1959 and 1979. Materials and methods: We conducted a descriptive and retrospective study based on the malariometric and operational results of the MEC in Colombia from 1959 to 1979 compiled from the archives of the Ministry of Public Health. We used the criteria defined by the WHO Expert Committee on Malaria. The information was stored, tabulated, and analyzed based on the malariometric indicators we developed. Results: In the short-term eradication period (1959-1969), a reduction of 94% (4,172) in transmission was achieved during the first year of the attack phase (1959) while in the last year (1962), there was an 88% (8,426) reduction of the accumulated load of cases compared to the annual average of the 1950s (71,031). These low levels of transmission were maintained until the end of 1969. During the intensification period of control of the eradication (1970-1979), there was an increase in malaria endemicity and a resurgence of the epidemic transmission. Due to financial problems affecting the regularity of the operations, Colombia was unable to sustain the results and achieve an interruption of transmission, which resulted in a resurgence of cases during the attack and consolidation phases. Conclusions: The campaign did not achieve the goal of interrupting malaria transmission in the national territory but there was marked control in areas of medium and low intensity.

Introducción. A mediados de la década de 1950, el país adoptó e implementó la Campaña de Erradicación de la Malaria (CEM), sin que hasta ahora se haya hecho su evaluación. Objetivo. Evaluar los resultados alcanzados en las fases de ataque y consolidación de la campaña de erradicación de la malaria en Colombia, entre 1959 y 1979. Materiales y métodos. Se hizo un estudio descriptivo y retrospectivo de los resultados "malariométricos" y operacionales de la CEM en Colombia entre 1959 y 1979 a partir de los datos recopilados de los archivos del Ministerio de Salud Pública. Se utilizaron los criterios establecidos por la Organización Mundial de la Salud (OMS) relacionados con las fases de un programa de erradicación de malaria. Se almacenó, tabuló y analizó la información, y se elaboraron y aplicaron indicadores malariométricos. Resultados. En el periodo de erradicación a corto plazo (1959-1969), durante el primer año de la fase de ataque (1959), se alcanzó una reducción de la transmisión del 94 % (4.172) y, en el último año (1962), una disminución del 88 % (8.426) en la carga acumulada de casos comparada con el promedio anual de la década del 50 (71.031); estos bajos niveles de transmisión se mantuvieron hasta finales de 1969. En el periodo de intensificación del control para la erradicación (1970-1979), se produjo un incremento de la endemia y resurgió la transmisión epidémica. Debido a problemas financieros que afectaron la regularidad de la operación para mantener los resultados, y no habiéndose logrado la interrupción de la transmisión, se observó un resurgimiento de casos en las fases de ataque y consolidación. Conclusiones. La campaña no logró la meta de interrupción de la transmisión de la malaria en el territorio nacional, pero sí se consiguió un acentuado control en áreas de mediana y baja intensidad.

Analysis of interactions of actors of the knowledge network on malaria in Colombia / Análisis de interacciones de actores de la red de gestión del conocimiento en malaria de Colombia

Introduction: Malaria is a disease with a high impact on Colombian population, which must be approached from the point of view of teamwork of institutions for knowledge exchange. Objective: To analyze the interactions of the Red de Gestión del Conocimiento, Investigación e Innovación en Malaria de Colombia. Materials and methods: An analysis of social networks was applied that allowed identifying the proximity between actors and the degree of knowledge between them. Indicators of density, diameter, average distance, and degree of centrality were observed. The documentary corpus for the study consisted of 193 technical documents published between 2016 and 2021, which were analyzed using text mining using the R programming language. The network was categorized based on five variables: comprehensive patient care, diagnosis, epidemiology and health information analysis systems, public policy and promotion and prevention. Results: The analysis of interactions indicated that the network was made up by 99 actors. The main interest in knowledge production was on epidemiology and health information analysis systems (98 % of the actors), followed by the integral patient care (80 % of the actors). On the contrary, the least approached category was malaria promotion and prevention practices (54 % of the actors). Conclusions: In general, this study contributes to the strengthening of key strategies in the dissemination of knowledge about malaria in Colombia.

Introducción. La malaria, o paludismo, es una enfermedad de gran impacto en la población colombiana, que debe ser abordada desde el punto de vista del trabajo en equipo de instituciones para el intercambio de conocimiento. Objetivo. Analizar las interacciones de la Red de Gestión del Conocimiento, Investigación e Innovación en Malaria de Colombia. Materiales y métodos. Se hizo un análisis de redes sociales que permitió identificar la proximidad entre los actores y el grado de conocimiento entre ellos; se observaron indicadores de densidad, diámetro, distancia media y centralidad de grado. El corpus documental para el estudio estuvo constituido por 193 documentos técnicos publicados entre el 2016 y el 2021, que fueron analizados empleando técnicas de procesamiento de texto mediante el lenguaje de programación R. La categorización de la red se realizó a partir de cinco variables: atención integral a pacientes, diagnóstico, epidemiología y sistemas de análisis de información en salud, política pública, y promoción y prevención. Resultados. El análisis de las interacciones indicó que la red la conformaban 99 actores, de los cuales 97 (98 %), mostraron más interés en la producción de conocimientos en epidemiología y sistemas de análisis de información en salud, seguido de la categoría de atención integral a pacientes con 79 (80 %). El 54 % de los actores llevó a cabo estudios de promoción y prevención, siendo esta la categoría de menor abordaje. Conclusiones. Este estudio contribuye al fortalecimiento de estrategias clave en la divulgación del conocimiento sobre la malaria en Colombia.

Dexamethasone and COVID-19: Strategies in Low- and Middle-Income Countries to Tackle Steroid-Related Strongyloides Hyperinfection.

COVID-19 can trigger a systemic inflammatory response that in some cases leads to severe lung involvement, multisystem dysfunction, and death. Dexamethasone therapy, because of its potent anti-inflammatory effects, has been proposed for the management of hospitalized patients with severe COVID-19. The subject of this article is to discuss potential strategies to tackle Strongyloides hyperinfection in hospitalized patients with COVID-19 receiving dexamethasone therapy in low- and middle-income countries. In this context, dexamethasone treatment has been found to be generally safe. However, its use in people coinfected with undetected Strongyloides stercoralis increases the risk for Strongyloides hyperinfection/dissemination a potentially fatal complication. Infection caused by S. stercoralis may remain asymptomatic or with mild symptoms in humans for several years. Early detection and specific treatment prevent a fatal evolution of this complication, but the challenge is to screen before corticosteroid therapy. In some cases, presumptive treatment may be justified. Ivermectin is the gold standard for treatment.

Comparison of Health-Related Quality of Life in Outpatients with Chagas and Matched Non-Chagas Chronic Heart Failure in Colombia: A Cross-Sectional Analysis.

Chagas disease represents an important cause of heart failure (HF) and affects health-related quality of life (HRQoL). The study aimed to evaluate and compare the HRQoL of patients with chagasic HF and matched non-Chagas controls to identify factors associated with HRQoL. A cross-sectional study with pair-matched controls was conducted in Colombia. From October 2018 to December 2019, a total of 84 HF patients were screened for study subjects. Four were excluded, resulting in 80 patients for the analysis, among whom 40 patients with Chagas were enrolled as cases and 40 gender- and age-matched non-Chagas patients as controls. The Kansas City Cardiomyopathy Questionnaire (KCCQ) and the Minnesota Living with Heart Failure Questionnaire (MLWHFQ) were used to measure HRQoL. Demographic, clinical, and laboratory data were obtained from each subject. Health-related quality of life scores were significantly worse among the Chagas group than among the non-Chagas group in the KCCQ domains of physical functioning and symptoms and in the MLWHFQ scale. In the multivariate analysis, the variables associated with lower HRQoL scores were living alone, obesity, having less than 12 years of education, and an increase in left ventricular diameters in the systole and diastole. Health-related quality of life in patients with chronic HF is impaired across all domains. Chagas patients showed worse HRQoL scores than non-Chagas patients. Six variables, some potentially modifiable, were independently associated with worse HRQoL.

Leishmaniasis in the Colombian post-conflict era: a descriptive study from 2004 to 2019.

INTRODUCTION: Leishmaniasis is strongly associated with armed conflict. We describe the epidemiology of leishmaniasis before and after the peace agreement in Colombia. METHODS: Data for 2004-2019 period were collected from the National Public Health Surveillance System. The annual incidence per geographical department before and after the peace agreement was calculated and correlated with armed conflict severity. RESULTS: The annual incidence of leishmaniasis registered a downfall with an annual percentage change of 17.7% after the peace treaty. CONCLUSIONS: A decrease in hostilities has a positive impact on the leishmaniasis incidence, which may be the case for other public health issues.

The Cost of Lost Productivity Due to Premature Chagas Disease-Related Mortality: Lessons from Colombia (2010-2017).

BACKGROUND: Economic burden due to premature mortality has a negative impact not only in health systems but also in wider society. The aim of this study was to estimate the potential years of work lost (PYWL) and the productivity costs of premature mortality due to Chagas disease in Colombia from 2010 to 2017. METHODS: National data on mortality (underlying cause of death) were obtained from the National Administrative Department of Statistics in Colombia between 2010 and 2017, in which Chagas disease was mentioned on the death certificate as an underlying or associated cause of death. Chagas disease as a cause of death corresponded to category B57 (Chagas disease) including all subcategories (B57.0 to B57.5), according to the Tenth Revision of the International Statistical Classification of Diseases and Related Health Problems (ICD-10). The electronic database contains the number of deaths from all causes by sex and 5-year age group. Economic data, including wages, unemployment rates, labor force participation rates and gross domestic product, were derived from the Bank of the Republic of Colombia. The human capital approach was applied to estimate both the PYWL and present value of lifetime income lost due to premature deaths. A discount rate of 3% was applied and results are presented in 2017 US dollars (USD). RESULTS: There were 1261 deaths in the study, of which, 60% occurred in males. Premature deaths from Chagas resulted in 48,621 PYWL and a cost of USD 29 million in the present value of lifetime income forgone. CONCLUSION: The productivity costs of premature mortality due to Chagas disease are significant. These results provide an economic measure of the Chagas burden which can help policy makers allocate resources to continue with early detection programs.

Malaria mortality in Colombia from 2009 to 2018: a descriptive study.

INTRODUCTION: Colombia has an endemo-epidemic for malaria, with a downward trend in mortality over the last few decades. This study describes the malaria mortality rates from 2009-2018. METHODS: We obtained data from the Colombian Mortality Information System and calculated the case fatality and crude and age-adjusted mortality rates. RESULTS: During the study, 148 malaria-related deaths were registered. The average annual mortality rate was 0.032 deaths/100,000. Two peaks were observed in 2010 and 2016. Choco contributed to the highest number of deaths (27.7%). CONCLUSIONS: The unstable downward trend of malaria mortality rates calls for greater emphasis on surveillance and interventions.