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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.
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Doença de Chagas , Humanos , Masculino , Doença de Chagas/diagnóstico , Doença de Chagas/epidemiologia , Adulto , Colômbia , Doença Aguda , Saúde da População UrbanaRESUMO
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.
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Se presenta un caso de enfermedad de Chagas en fase aguda en un paciente masculino de 40 años, proce-dente 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 aplic-aron medidas de educación sanitaria para prevenir la propagación de la enfermedad.
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Humanos , MasculinoRESUMO
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.
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Malária , Humanos , Colômbia/epidemiologia , Malária/epidemiologia , Estudos RetrospectivosRESUMO
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.
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.
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Plasmodium vivax , Saúde Pública , Doenças Transmitidas por Vetores , Malária , Plasmodium falciparum , Fatores Epidemiológicos , Surtos de Doenças , Região do CaribeRESUMO
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.
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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.
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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.
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Helmintíase , Enteropatias Parasitárias , Criança , Pré-Escolar , Colômbia/epidemiologia , Helmintíase/epidemiologia , Humanos , Enteropatias Parasitárias/epidemiologia , Enteropatias Parasitárias/parasitologia , Prevalência , Instituições AcadêmicasRESUMO
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.
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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 (ORâ=â3; 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.
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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.
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Malária Falciparum , Malária Vivax , Malária , Humanos , Adulto , Colômbia/epidemiologia , Estudos Retrospectivos , Malária/epidemiologia , Malária Vivax/epidemiologia , Região do CaribeRESUMO
BACKGROUND: Identifying risk factors for Triatominae infestation is essential for the development of vector control interventions. METHODS: To determine the intra- and peridomiciliary risk factors associated with triatomine infestation, a cross-sectional analytical study was carried out with random cluster sampling in two stages, which included the identification of risk factors by survey and direct observation, as well as the search and capture of triatomines. The detection of trypanosomes in triatomines was carried out by observing the rectal content and then by conventional polymerase chain reaction (PCR). RESULTS: In 21 of the 207 houses inspected, 13 specimens of R. colombiensis and 19 specimens of P. geniculatus were found. Entomological indices included: dispersion 36%, infestation 10%, infection 65%, colonization 4.7%, density 15%, and concentration 152%. An association was found between the presence of Triatominae and the existence of branches and fissures in the floors, as well as with the presence of accumulated objects and with knowledge about Chagas disease. The risk of having triatomines in urban homes is 5.7 times higher than the risk in rural areas [confidence interval (CI) 0.508-67.567]; 6.6 times in houses with cracked soil (CI 0.555-81.994), 6 times in houses located near caneys (CI 0.820-44.781), and 6.16 times with accumulated objects (CI 1.542-39.238). CONCLUSION: Chagas disease is a complex problem that requires control based on the vector's elimination or surveillance, which implies identifying species and their distribution, generating alerts, knowledge, and awareness in the population. It is necessary to intensify surveillance activities for the event, especially in changing aspects of Chagas diseases' transmission dynamics, such as urbanization and the type of housing associated with the vector's presence.
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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.
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Tratamento Farmacológico da COVID-19 , Dexametasona/efeitos adversos , SARS-CoV-2 , Strongyloides stercoralis , Estrongiloidíase/etiologia , Animais , Países em Desenvolvimento , Estrongiloidíase/tratamento farmacológicoRESUMO
BACKGROUND: Heterogeneity and focalization are the most common epidemiological characteristics of endemic countries in the Americas, where malaria transmission is moderate and low. During malaria elimination, the first step is to perform a risk stratification exercise to prioritize interventions. This study aimed to identify malaria risk strata in the ecoepidemiological regions of Colombia. METHODS: This was a descriptive and retrospective study using cumulative malaria cases in 1,122 municipalities of Colombia from 2010 to 2019. To identify the strata, the criteria proposed by PAHO were adapted. To classify the receptive areas (strata 2, 3, and 4) and nonreceptive areas (stratum 1), 1,600 m above sea level, ecotypes, main malaria vector presence, Plasmodium species prevalence and occurrence of malaria cases were used. The area occupied by the receptive municipalities, the cumulative burden, and the at-risk population in the regions were calculated. RESULTS: Ninety-one percent of the Colombian territory is receptive to the transmission of malaria and includes 749 municipalities with 9,734,271 (9,514,243-9,954,299) million at-risk inhabitants. Stratum 4 accounted for 96.7% of the malaria burden, and cases were concentrated primarily in the Pacific and Uraba-Bajo Cauca-Sinu-San Jorge regions. Plasmodium vivax predominates in most of the receptive municipalities, except in the municipalities of the Pacific region, where P. falciparum predominates. Anopheles albimanus, An. nuneztovari s.l., and An. darlingi were the main vectors in receptive areas. CONCLUSIONS: In Colombia, 91.2% of the territory is receptive to the transmission of malaria and is characterized by being both heterogeneous and focused. Stratum 4 contains the greatest burden of disease, with a relatively greater proportion of municipalities with a predominance of P. vivax. However, there is a low proportion of municipalities with P. falciparum mainly in the Pacific region. These findings suggest that the latter be prioritized within the malaria elimination plan in Colombia.
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Malária Vivax/epidemiologia , Plasmodium vivax , Animais , Anopheles/parasitologia , Cidades , Colômbia/epidemiologia , Humanos , Estudos Retrospectivos , Medição de RiscoRESUMO
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.
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Doença de Chagas/psicologia , Doença Crônica/psicologia , Insuficiência Cardíaca/psicologia , Pacientes Ambulatoriais/psicologia , Pacientes Ambulatoriais/estatística & dados numéricos , Qualidade de Vida , Idoso , Colômbia , Estudos Transversais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Inquéritos e QuestionáriosRESUMO
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.
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BACKGROUND: Colombia has officially adopted the parasite density levels of severe malaria established by the WHO (>50,000 parasites/µl). These values have been inferred from areas of high transmission in Africa and are not consistent with the dynamics of low and unstable transmission in Colombia. The objective of this study was therefore to determine the parasite density values observed in patients with severe malaria and their distribution in the different ecoepidemiological regions of Colombia. METHODS: A retrospective and descriptive study of confirmed cases of severe malaria was conducted in endemic areas of malaria in Colombia over the period 2014-2017. Data were collected from secondary sources of the Subnational Programs of Malaria Prevention and Control. Person, place, and time variables were selected. The official definition of severe malaria was adopted, and compliance with these criteria was determined. Univariate and bivariate analyses were conducted with absolute and relative frequency measures, and the relevant statistical tests were applied. RESULTS: The overall parasite density values in Colombia showed a geometric mean of 5,919 parasites/µl (95% CI: 5,608-6,248). By parasite species, the values were 6,151 (95% CI: 5,631-6,718) for Plasmodium falciparum and 5,815 (95% CI: 5,428-6,230) for Plasmodium vivax. The highest parasite density values were recorded in the Amazon ecoepidemiological region (8,177; 95% CI: 6,015-11,116), and the lowest values were recorded in the Andean region (5,026; 95% CI: 2,409-10,480). CONCLUSIONS: In endemic areas of low and unstable malaria transmission in the Colombian territory, the parasite density levels observed in populations with severe malaria are lower than the officially established values. The parasite density criterion is not really a relevant criterion for the definition of severe cases in Colombia and it certainly not be used to make a clinical decision about the severity of the disease.
Assuntos
Malária Falciparum/epidemiologia , Malária Vivax/epidemiologia , Plasmodium falciparum/crescimento & desenvolvimento , Plasmodium vivax/crescimento & desenvolvimento , Densidade Demográfica , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Criança , Pré-Escolar , Colômbia/epidemiologia , Doenças Endêmicas/prevenção & controle , Feminino , Geografia , Humanos , Lactente , Malária Falciparum/parasitologia , Malária Falciparum/transmissão , Malária Vivax/parasitologia , Malária Vivax/transmissão , Masculino , Pessoa de Meia-Idade , Plasmodium falciparum/fisiologia , Plasmodium vivax/fisiologia , Prevalência , Estudos Retrospectivos , Índice de Gravidade de Doença , Adulto JovemRESUMO
Artemether-lumefantrine (AL) is the first-line treatment for uncomplicated Plasmodium falciparum infection in Colombia. To assess AL efficacy for uncomplicated falciparum malaria in Quibdo, Choco, Colombia, we conducted a 28-day therapeutic efficacy study (TES) following the WHO guidelines. From July 2018 to February 2019, febrile patients aged 5-65 years with microscopy-confirmed P. falciparum mono-infection and asexual parasite density of 250-100,000 parasites/µL were enrolled and treated with a supervised 3-day course of AL. The primary endpoint was adequate clinical and parasitological response (ACPR) on day 28. We attempted to use polymerase chain reaction (PCR) genotyping to differentiate reinfection and recrudescence, and conducted genetic testing for antimalarial resistance-associated genes. Eighty-eight patients consented and were enrolled; four were lost to follow-up or missed treatment doses. Therefore, 84 (95.5%) participants reached a valid endpoint: treatment failure or ACPR. No patient remained microscopy positive for malaria on day 3, evidence of delayed parasite clearance and artemisinin resistance. One patient had recurrent infection (12 parasites/µL) on day 28. Uncorrected ACPR rate was 98.8% (83/84) (95% CI: 93.5-100%). The recurrent infection sample did not amplify during molecular testing, giving a PCR-corrected ACPR of 100% (83/83) (95% CI: 95.7-100%). No P. falciparum kelch 13 polymorphisms associated with artemisinin resistance were identified. Our results support high AL efficacy for falciparum malaria in Choco. Because of the time required to conduct TESs in low-endemic settings, it is important to consider complementary alternatives to monitor antimalarial efficacy and resistance.
Assuntos
Antimaláricos/uso terapêutico , Combinação Arteméter e Lumefantrina/uso terapêutico , Malária Falciparum/tratamento farmacológico , Adolescente , Adulto , Fatores Etários , Idoso , Antimaláricos/administração & dosagem , Combinação Arteméter e Lumefantrina/administração & dosagem , Criança , Pré-Escolar , Colômbia , Resistência a Medicamentos/genética , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Plasmodium falciparum/efeitos dos fármacos , Plasmodium falciparum/genética , Polimorfismo de Nucleotídeo Único/genética , Resultado do Tratamento , Adulto JovemRESUMO
OBJECTIVE: To quantify the costs of Chagas disease in Colombia from a societal perspective in 2017. METHODS: A cost-of-illness analysis was carried out using a prevalence-based approach. Costs attributable to Chagas were estimated from a bottom-up strategy, using population attributable fractions. Indirect costs were calculated using the human capital approach. RESULTS: The estimated total cost of diagnosed Chagas disease was US $13.1 million and included $5.7 million in direct medical costs, $1.5 million in direct nonmedical costs, and $5.8 million in indirect costs: absenteeism ($2.2 million), presenteeism ($3.1 million), and premature deaths ($515228). On average, people diagnosed with Chagas disease incurred $594 in medical expenses, and more than half of that expense was directly attributable to Chagas. The annual cost to society for a person with chronic Chagas disease was $4226. CONCLUSIONS: Chagas disease imposes a substantial financial burden on healthcare system and society. Economic cost of illness-related productivity losses is much more significant. Our research suggests that a health policy framework addressing as many of the social determinants of health as possible may be pivotal in containing social costs. Therefore, reducing this burden is not only the responsibility of the health system.
Assuntos
Doença de Chagas/economia , Absenteísmo , Adolescente , Adulto , Idoso , Colômbia , Efeitos Psicossociais da Doença , Eficiência , Feminino , Custos de Cuidados de Saúde , Humanos , Masculino , Pessoa de Meia-Idade , Prevalência , Adulto JovemRESUMO
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.