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PubMed2002

Malaria control reinvented: health sector reform and strategy development in Colombia.

The consequences of health sector reforms on control of malaria were analysed using Colombia as an example. One of the most complex health sector reform programmes in Latin America took place in the 1990s; it included transferring the vertical vector-borne disease control (VBDC) programme into health systems at state and district levels. A series of studies was undertaken in 1998-2000 at the national level (Ministry of Health Study), at the state level (Departamento Study) and at the health district level (District Study) using formal and informal interviews among control staff and document analysis as data collection tools. A government-financed national training programme for VBDC staff - which included direct observation of control operations - was also used to analyse health workers' performance in the postreform period (longitudinal study). The results showed that some shortcomings of the old vertical system, such as the negative aspects of trade union activity, have not been overcome while some positive aspects of the old system, such as capacity building, operational planning and supervision have been lost. This has contributed to a decrease in control activity which, in turn, has been associated with more malaria cases. Malaria control had to be reinvented at a much larger scale than anticipated by the reformers caused by a whole series of problems: complex financing of public health interventions in the new system, massive staff reductions, the difficulty of gaining access to district and state budgets, redefining entire organizations and - in addition to the reforms - introducing alternative strategies based on insecticide-treated materials and the growth of areas of general insecurity in many parts of Colombia itself. However, positive signs in the transformed system include: the strengthening of central control staff (albeit insufficient in numbers) when transferred from the Ministry of Health to the National Institute of Health, the opportunities offered by the Basic Health Plan (PAB) for new planning initiatives and intersectoral co-operation and the integration of malaria diagnosis and treatment into the general health services (associated with a decrease of malaria mortality). The potentials of the new system have not yet been fully exploited: capacity building, communication and management skills need to be improved and it require guidance from the national level.

Colombia↗

PubMed2003

Short communication: point mutations in the dihydrofolate reductase and dihydropteroate synthase genes of Plasmodium falciparum isolates from Colombia.

Point mutations in the dihydrofolate reductase (DHFR) and dihydropteroate synthase (DHPS) genes of Plasmodium falciparum can lead to an increasing resistance of P. falciparum to pyrimethamine/sulphadoxine. We examined the prevalence of these mutations in 36 samples from Colombia. Analysed by polymerase chain reaction (PCR) for infection with P. falciparum, 25 (69%) tested positive. These positive isolates were tested further for point mutations in the genes of DHFR (codons 16, 51, 59, 108 and 164) and DHPS (codons 436, 437, 540, 581 and 613) by nested PCR and following mutation-specific restriction enzyme digestion. Gene mutations occurred in both the DHFR and DHPS gene of the Colombian isolates, suggesting that resistance to antifolate drugs exists or may develop soon in Colombia.

Adult↗

PubMed2003

IgG antibody reactivity to Borrelia burgdorferi sensu stricto antigens in patients with morphea in Colombia.

BACKGROUND: Morphea and lichen sclerosus et atrophicus (LSA) are sclerotic skin lesions of unknown etiology involving connective tissue. The hypothesis of a borrelial origin of morphea and LSA is currently controversial. METHODS: Immunoglobulin G (IgG) immunoblot serologies against Borrelia burgdorferi in patients with morphea and LSA were analyzed and compared with those from healthy donors and patients with syphilis to determine the association with a probable borrelial agent in Colombia. RESULTS: No significant differences in the number of reactive antigenic bands were found between morphea/LSA patients and syphilis patients or healthy donors. The presence of at least one of the following bands, p28, p39, or p45, was the criterion most able to distinguish morphea/LSA, yielding a specificity of 95% and a sensitivity of 28.6%. Using this criterion as evidence of putative exposure to a causative borrelial agent, sclerotic skin lesions had an odds ratio of 7.60 (95% confidence interval, 1.47-39.23). CONCLUSIONS: These results could be explained by cross-reactivity; however, the partial shared reactivity of sera from patients with syphilis and morphea/LSA does not rule out the possibility that a new spirochetal agent, unrelated to B. burgdorferi or Treponemas, may be the causative agent of morphea/LSA in Colombia.

Adolescent↗

PubMed2003

A unique form of endemic pemphigus in northern Colombia.

BACKGROUND: Endemic forms of pemphigus are a unique group of autoimmune diseases that represent opportunities to study interactions of the environment and genetics with the immune system. The restriction to relatively well-defined regions of South and Central America and perhaps Africa characterizes these diseases. OBJECTIVES: The aims of this study were to confirm the endemic nature of a new type of autoimmune disease occurring in a mining town in northeastern Colombia in the El Bagre area, to characterize it, and to compare it with other forms of endemic pemphigus. METHODS: A 10-year prospective, controlled epidemiologic, humanitarian, and immunologic fieldwork case-control survey was performed in El Bagre, Colombia. RESULTS: Our work revealed that this disease is endemic in rural areas surrounding El Bagre. The disease appeared in 4.7% of middle-aged and older men and postmenopausal women from these rural areas. This disease differs from previously described forms of endemic pemphigus. It shares some heterogeneous immunoreactivity with paraneoplastic pemphigus but is not associated with malignant tumors. The disease resembles Senear-Usher syndrome (pemphigus and lupus) but occurs endemically either with a localized stable clinical course or in a systemic form. This systemic form may affect organs other than skin and is characterized by episodic relapses and poor prognosis in comparison with the localized form. CONCLUSION: We have confirmed endemic pemphigus foliaceus in El Bagre as an autoimmune disease that shares features with Senear-Usher syndrome but occurs in an endemic fashion. Heterogeneous antigenic reactivity is observed as in paraneoplastic pemphigus but with no evidence of association with neoplasia. In addition, constant exogenous antigenic stimulation and a genetic predisposition may be required in the pathogenesis of this disease.

Autoimmune Diseases↗

PubMedDate not supplied

Road traffic injuries in Colombia.

Road traffic injuries are a leading public health problem in Colombia. Pedestrians are the most vulnerable road users, especially in the main urban centers of Bogotá, Medellin and Cali. Data analyzed in this report include official statistics from the National Police and the National Institute of Legal Medicine and Forensic Sciences for 1996-2000, and results of a study conducted at the National University of Colombia in 2000. Methods from the Highway Capacity Manual were used for determining physical and technical variables, and a Geographical Information System tool was used for the location and spatial analysis of the road traffic crashes. Pedestrians accounted for close to 32% of injuries and 40% of the deaths from road traffic crashes. The problem of road traffic crashes existed predominately in urban areas. In the main urban centers, pedestrians constituted nearly 68% of road traffic crash victims. The high level of risky road use behaviors demonstrated by pedestrians and drivers, and inadequate infrastructure for safe mobility of pedestrians in some sections of the road network were the main contributing factors. Major improvements were achieved in Bogotá following enhancements to the municipal transport system and other policies introduced since 1995. In conclusion, policies and programs for improving road safety, in particular pedestrian safety, and strengthening urban planning are top priority.

Accidents, Traffic↗

PubMed2005

Biological control of the coffee berry borer Hypothenemus hampei (Coleoptera: Curculionidae) by Phymastichus coffea (Hymenoptera: Eulophidae) in Colombia.

The potential of the eulophid parasitoid Phymastichus coffea LaSalle to control coffee berry borer Hypothenemus hampei (Ferrari) populations under field conditions in Colombia was evaluated. Parasitoid adults were released one, five and nine days after artificial infestations of 90-, 150- and 210-day-old coffee berries with H. hampei females. The position of the beetle inside the berry and the parasitism levels were assessed ten days after each P. coffea release. Parasitism of H. hampei by P. coffea was significantly affected by the age of the berries at the time of infestation, and by the position of the beetle inside the berries. Highest levels of parasitism were recorded in 150-day-old berries (75-85%) and in 90-day-old berries (75%) when P. coffea were released one day after the artificial infestation with H. hampei. In 150-day-old berries, highest levels of parasitism were recorded for H. hampei found in the outer layer of the endosperm followed by beetles penetrating the exocarp. Increasing the time of P. coffea releases after the artificial infestations with H. hampei led to decreased levels of parasitism in beetles attacking 90- and 150-day-old coffee berries. Low levels of parasitism were recorded in H. hampei females infesting older coffee berries because most of the beetles had already constructed galleries deep in the endosperm of the berries, i.e. out of reach of the parasitoid. The potential of P. coffea for biological control of coffee berry borer in Colombia is discussed.

Animals↗

PubMed1985

Isozyme profiles of Trypanosoma cruzi stocks from Colombia and Ecuador.

A total of 74 of 82 domestic Rhodnius prolixus from the same locality in eastern Colombia were found to be infected with Trypanosoma cruzi or T. rangeli. One of three domestic Triatoma dimidiata from Ecuador also showed T. cruzi infection. A total of 59 T. cruzi stocks from these and five other localities in Colombia were isolated from man, marsupials and triatomine bugs. Cellulose-acetate electrophoresis of nine or ten enzymes characterized all T. cruzi stocks as zymodeme 1 (reference clone Silvio X10/1). Differences in electrophoretic patterns between the newly isolated stocks and the zymodeme 1 standard were seen with the enzymes G6PD and HK. These results are in agreement with the previously described geographical distribution of T. cruzi zymodemes. Stocks were isolated from both low and high altitudes and there was no evidence of adaptative significance of T. cruzi enzyme polymorphism.

Animals↗

PubMedDate not supplied

A dynamic, multi-level analysis of recent immunization trends in Colombia.

During 1985-91, Latin American ministries of health carried out the ultimately successful Regional Polio Eradication Initiative. Unprecedented vaccine coverage levels were attained through a combination of mass campaigns, house-to-house vaccinations, and improvements in routine immunization services. Little is known, however, about the effects of these interventions on immunization demand; whether they reached so-called high-risk households and, if so, whether program effects were sufficient to offset the household risk factors. This paper examines the probability and timing of full immunization over this period in one case country, Colombia. Information on the immunization status of 3,609 vaccine-eligible children born 1985-90 was extracted from Colombia's 1990 Demographic and Health Survey. Annual immunization coverage estimates from the Colombian Ministry of Health for 1985-90 for 148 sample municipios were appended to each child record, along with household-level data. Initial non-parametric regressions showed that five of six observed risk factors negatively influenced full immunization probability. Multivariate logit models showed that parents who had already lost a child were significantly less likely to obtain immunization cards (a proxy for exposure to the routine immunization program), despite rising cardholdership rates over the period. Among 1,376 immunization cardholders, waiting times to full immunization fell monotonically over the period. Local program coverage of 80 per cent or higher and prior use of prenatal services both increased the probability of full immunization. However, three of five maternal occupational categories decreased the probability, as did three of six observed household risk factors. The results show that demand for routine immunizations rose over the period, that only the highest-risk households were not exposed to the routine program, and that routine program participation partially offset negative risk factor effects on the probability of full immunization. While targeted PHC interventions may increase health production by recruiting high-risk households into the routine PHC services, further health production increases will require more intensive follow-up of such households through routine PHC services.

Child, Preschool↗

PubMed2001

Presence of international multiresistant clones of Streptococcus pneumoniae in Colombia.

In Colombia, penicillin resistance of Streptococcus pneumoniae invasive isolates recovered from children less than 5 years old has increased from 10% in 1994 to 49.4% in 1999, suggesting the circulation of international resistant clones in the country. A total of 167 S. pneumoniae invasive isolates with diminished susceptibility to penicillin (DSP) were studied. The techniques used were pulsed-field gel electrophoresis (PFGE) and restriction fragment length polymorphism (RFLP) of penicillin-binding proteins (PBPs) genes (2B, 2X, and 1A). Forty-nine serotype 23F isolates were grouped in two clusters: 15 (31%) multiresistant isolates showed PFGE pattern A and PBP I profile, thus making them indistinguishable from Spain23F-1 clone, and 34 (69%) with PFGE pattern C, PBP II profile, and intermediate level resistance (ILR) to penicillin and TMP-SMX, features unique to a Colombian clone. Fifty-five serotype 14 isolates were assigned to PFGE B pattern, PBP III profile, having high-level resistance to penicillin, and TMP-SMX, similar to the France9V variant 14. This same pattern was present in five capsular type 9V isolates. Four serotype 14 isolates were assigned to PFGE pattern F, and appeared to be similar to Slovakia(14)-10 PFGE pattern, although they had different PBP profiles. Nine capsular type 6B and one 6A isolates belonged to PFGE pattern M, similar to Spain6B-2, although they showed different PBP profiles. The remaining 44 isolates, corresponding to serotypes 14, 6B, 19F, and 34, showed variable PFGE and PBP patterns. These results show that as many as two international clones may be circulating in Colombia as well as a unique, widely distributed 23F clone with ILR to penicillin. Additionally, some Colombian isolates capsular type 14 and 6B might be related to Slovakia(14)-10 Spain6B-2 clones, respectively.

Bacterial Proteins↗

PubMed1994

Geographic independence of HTLV-I and HTLV-II foci in the Andes highland, the Atlantic coast, and the Orinoco of Colombia.

To clarify the ethnic specificity of human T cell leukemia virus type I (HTLV-I) and type II (HTLV-II) carriers among Colombian native Indians, we investigated the geographic distribution of HTLV-I and HTLV-II seroprevalence among the isolated ethnic groups of Mongoloid origin in the Andes highlands and the Atlantic coast of Colombia. HTLV-I carriers were found in 1.6% (1/62 samples) of Inga, 8.5% (5/59) of Kamsa, and 0% (0/55) of Cumbal Indians who live in the Andes highlands at 3000 m above sea level. On the other hand, HTLV-II carriers were found in 4.1% (5/123) of Wayuu Indians, who live in the Guajira region of the Atlantic coast of Colombia at a distance of 1000 km from the Andes highlands. This ethnic specificity of HTLV-II was similarly observed among Guahibo Indians in the Orinoco. The seroprevalence of HTLV-I and HTLV-II was mutually exclusive among Inga, Kamsa, and Wayuu Indians. These results suggest that HTLV-I and HTLV-II may have evolved among Mongoloid populations and been independently transmitted among two different lineages of Colombian native Indians, Andes highlanders and Atlantic coast lowlanders.

Adolescent↗

PubMed2006

First case of HIV Type 1 subtype F among men who have sex with men in Colombia.

To study the molecular epidemiology of human immunodeficiency virus (HIV) strains among men who have sex with men (MSM), the main high-risk group for HIV infection in Colombia, 113 HIV-positive MSM subjects recruited in Bogotá during the year 2002 were genotyped. By heteroduplex mobility assay (env HMA) all samples were classified as subtype B. Partial sequencing of the protease and the reverse transcriptase (Pro/RT) regions performed on a random subset of 10 samples revealed that nine were classified as subtype B, and one sample was subtype F. The specimen that is subtype F in pol and subtype B in env is likely to be is either a recombinant or a dual infection. In this study, we identify the HIV F subtype for the first time in Colombia.

Adolescent↗

PubMed1997

Distribution of capsular types and antimicrobial susceptibility of invasive isolates of Streptococcus pneumoniae in Colombian children. Pneumococcal Study Group in Colombia.

Streptococcus pneumoniae is the leading bacterial cause of childhood pneumonia in the developing world. This study describes the type distribution and antimicrobial susceptibility of invasive pneumococcal isolates from Colombian children and is part of the Sistema Regional de Vacunas (SIREVA), a PAHO regional initiative designed to determine the ideal serotype composition of a protein polysaccharide pneumococcal conjugate vaccine for use in children less than 5 years old in Latin America. In Colombia, during the study period, centres in Bogota, Medellin, and Cali collected 324 S. pneumoniae isolates from invasive diseases, 238 (73.5%) from children under the age of 2. Pneumonia was the clinical diagnosis in 41.3% cases, meningitis in 41%, and sepsis in 11.2%. The seven most frequent types included 14(21.9%), 5(10.5%), 23F(9.6%), 1(9%), 6B(9%), 19F(7.1%), and 6A(6.2%). The frequency of diminished susceptibility to penicillin (DSP) was 12%, with 8.9% of isolates showing intermediate level resistance and 3.1% showing high level resistance. Among DSP isolates, 23% were also resistant to cefotaxime, 33.3% to erythromycin, 48.7% to chloramphenicol, and 74.3% to trimethoprim/sulfamethoxazole. Multiple resistance was detected in 59% of the isolates that have DSP. Penicillin resistance was associated with types 23F (53.8%) and 14 (25.6%). These data provides information on capsular types prevalent in Colombia that will not only allow the formulation of an ideal vaccine for the region but also reinforce the need for ongoing regional surveillance.

Anti-Bacterial Agents↗

PubMed2005

Rural telemedicine infrastructure and services in the Department of Cauca, Colombia.

The development of telemedicine programs for the public health network of the Department of Cauca, Colombia, (Department is the major political and territorial division of the country. The Department of Cauca is located on the Pacific coast in the southwest of the country.) would make it possible to satisfy many identified needs such as medical coordination, continuing education, epidemiologic surveillance, patient referral and counterreferral, and an end to the feeling of isolation among professionals who work in rural health centers. Nevertheless, geographic, economic, and social difficulties, and the lack of a telecommunication infrastructure in areas with these characteristics present a challenge of such magnitude that the majority of existing telemedicine projects in Colombia have been centered in urban or other areas which present fewer difficulties. In the municipality of Silvia, the University of Cauca has established a prototype network using the "Hispano-American Health Link" (EHAS in Spanish) program technologies, which uses very high frequency (VHF) and wireless fidelity, (WiFi, a set of standards for wireless local area networks) radio systems for the deployment of low-cost voice and data networks. Over this network information access and exchange services have been developed, in order to meet the needs identified above. The objectives were to obtain information about the development of the project's activities and their possible impact. Project telecommunication network and information services are described, and the results and conclusions of the first evaluation are presented.

Colombia↗

PubMed1994

The socioeconomic impact of malaria in Colombia and Ecuador.

In-depth studies in three communities of Colombia and Ecuador, over a period of two to three months in each, were the basis of the economic analysis presented in this paper. In Santa Cruz, located at the rio Naya in Colombia, the average cost per case of malaria was US$17.30 (indirect costs US$15.80 and direct costs US$1.50); the loss corresponded to 20.1% of a minimum monthly wage (1986) or to a value of 5.6 days' work. In Perla de Sade, in the Cant6n Quininde of Ecuador, the average cost per case of malaria amounted to US$10.40 (indirect costs US$5.90 and direct costs US$4.50); the losses corresponded to 20.8% of a minimum monthly wage (1989) and to a value of 5.7 days' work. In Calder6n in the Cant6n of San Lorenzo in Ecuador, the average cost per case of malaria was US$4.80 (indirect costs US$3.50 and direct costs US$1.30); the losses corresponded to 16.0% of a minimum monthly wage (1991) with a value of 4.4 days' work. The results in these three communities, and in four additional ones, showed that the major economic impact of malaria is in the reduction of the labour force of families (indirect costs), and less so in the direct costs of care and cure. This emphasizes the economic importance of malaria because the rural familes with economies at subsistence level depend for survival particularly upon the maintenance of their labour force.

Adolescent↗

PubMed1988

South American pemphigus foliaceus: study of an epidemic in El Bagre and Nechi, Colombia 1982 to 1986.

Between 1982 and 1986 we have had the chance to study 21 patients with pemphigus foliaceus of the 'fogo selvagem' type. The patients came from El Bagre and Nechi, rural areas of Colombia with some gold mining. This is the first outbreak of South American pemphigus foliaceus reported in Colombia. The majority of the patients were mestizo men, who worked as farmers or miners or both, with an average age of 44. Five patients were relatives. Eleven patients (52%) had mild disease, three (14%) moderate disease and seven (33%) severe disease. During hospitalization, three patients died due to complications or as a result of immunosuppressive treatment. Of the remaining 18 patients, 10 were in remission with treatment, one was in remission without treatment, while no information was available on the remaining seven.

Adult↗

PubMed1991

Usher syndrome: results of a screening program in Colombia.

Otological, ophthalmological and genetic studies were performed in 46 patients with Usher syndrome, identified through a screening program in Colombia. Of them, 69.6% had Usher syndrome type I, 26.1% type II, and 4.3% type III. Thirty-three patients showed profound deafness (71.7%), while 13 (28.3%) had moderate to severe hearing loss. The ophthalmologic manifestations showed marked variability. Although the majority of the patients had serious ocular impairment before age 20, 32.6% had good central visual acuity. The prevalence of Usher syndrome in Colombia, estimated at 3.2/100,000, warrants the implementation of screening programs in schools for the deaf and for the blind. Our study confirms that Usher syndrome shows no geographic or racial variation and that the disorder has a wide variability of expression and genetic heterogeneity. The large size of the families we have detected may provide important opportunities for further genetic studies, particularly in terms of the assignment of the locus and gene mapping.

Colombia↗

PubMed2006

Genetic and other diseases in the pottery of Tumaco-La Tolita culture in Colombia-Ecuador.

The people of Tumaco-La Tolita culture inhabited the borders of present-day Colombia and Ecuador. Already extinct by the time of the Spaniards arrival, they left a huge collection of pottery artifacts depicting everyday life; among these, disease representations were frequently crafted. In this article, we present the results of the personal examination of the largest collections of Tumaco-La Tolita pottery in Colombia and Ecuador; cases of Down syndrome, achondroplasia, mucopolysaccharidosis I H, mucopolysaccharidosis IV, a tumor of the face and a benign tumor in an old woman were found. We believe these to be among the earliest artistic representations of disease.

Colombia↗

PubMed1996

Results of Expedicion Humana. I. Analysis of HLA class II (DRB1-DQA1-DPB1) alleles and DR-DQ haplotypes in nine Amerindian populations from Colombia.

HLA class II variation was analyzed in nine Native American populations of Colombia using PCR/SSOP typing methods. Under the auspices of the Expedition Humana, approximately 30 unrelated native Colombia Indian samples each from the Tule (NW Pacific Coast), Kogui (Sierra Nevada). Ijka (Sierra Nevada), Ingano (Amazonas), Coreguaje (Amazonas), Nukak (Amazonas), Waunana (Pacific), Embera (Pacific) and Sikuani (Northeastern Plains) were collected and analyzed at the DRBI, DQA1, DQB1 and DPB1 loci. The number of different DRB1, DQA1, DQB1 and DPB1 alleles in the Colombian Indians is markedly reduced in comparison with neighboring African Colombian populations, which exhibit a very high degree of class II variability, as discussed in an accompanying paper. In the Colombian Amerindian groups, DR2 (DRB1*1602), DR4 (DRB1*0407, *0404, *0403 AND *0411), DR6 (DRB1*1402) and DR8 (DRB1*0802) comprise > 95% of all DRB1 alleles. We also found an absence of DR3 in all populations, and DR1, DR7 and DR9 allelic groups were either very rare or absent. Each Colombian Amerindian population has a predominant DRB1 allele (f = approximately 0.22-0.65) and DRB1-DQA1-DQB1 haplotype. Several novel DR-DQ haplotypes were also found. At the DPB1 locus, DPB1*0402 (f = 0.28-0.82), *1401 (f = 0.03-0.45), and *3501 (f = 0.03-0.27), were the three most prevalent alleles, each population maintaining one of these three alleles as the predominant (f > 0.26) DPB1 allele. The reduction of diversity for the HLA class II alleles in the Colombian Indians is suggestive of a population bottleneck during the colonization of the Americans, with little to no subsequent admixture with neighboring African Colombian populations in the last approximately 300 years.

Colombia↗