Objective: To explore the perceptions and experiences of pregnant women in accessing healthcare services during the epidemic in Colombia during 2015-2016. Methods:A qualitative study using semistructured interviews was conducted in Villavicencio. Six women who had been diagnosed with Zika virus infection during their pregnancies and whose fetus had suspected microcephaly participated in the investigation. Grounded theory was used and thematic content analysis was made for each category identified.Results: Three main themes affecting access to healthcare services were identified: (1) women knew basic information about the virus, but it was limited; (2) access to services was delayed due to their lack of availability or limited supply in the municipality; and (3) most of the participants made out-of-pocket payments to get access to services that were not provided. Conclusions:Several gaps were identified in the provision of healthcare services to pregnant women during the Zika epidemic. Policy makers need to utilize the results from affected communities to develop and implement public policies that adapt and respond to their priorities and needs.

Objectives:To describe the characteristics of pregnant women infected with Zika virus in two representative regions of Colombia, examine their pregnancy outcomes, and outline findings of the epidemiologic surveillance program established during the peak of the 2015-2016 epidemic. Methods:A cohort study conducted in the municipalities of Cali and Villavicencio using data from the National Public Health Surveillance System (SIVIGILA) and clinical follow-up data from pregnant women. We describe sociodemographic characteristics, health insurance status, Zika virus, pregnancy-related characteristics, and pregnancy outcomes.Results: A total of 1259 Zika-infected pregnant women were identified in Cali; of these, 2.3% (n=27) experienced pregnancy loss, 9.5% (n=113) had preterm birth, and 7.9% (n=91) had a low birthweight neonate. In Villavicencio, 3.0% (n=13) experienced pregnancy loss, 6.9% (n=30) had preterm birth, and 6.7% (n=28) had a low birthweight neonate. Compared with the general population, this population of Zika-infected pregnant women did not experience an increased frequency of preterm birth or low birthweight (relative risk of prematurity and low birthweight infant <1). Conclusions:Epidemiologic surveillance data showed that most neonates of Zika-infected pregnant women were born at term, and that the frequency of low birthweight neonates was low. Good quality data were obtained from the surveillance registries. K E Y W O R D S

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

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