Background: In conflict-afflicted areas, pregnant women and newborns often have higher rates of adverse health outcomes. Objective: To describe maternal and child health indicators and interventions between 1998 and 2016 comparing high and low conflict areas in Colombia. Methods: Mixed study of convergent triangulation. In the quantitative component, 16 indicators were calculated using official, secondary data sources. The victimization rate resulting from armed conflict was calculated by municipality and grouped into quintiles. In the qualitative component, a comparative case study was carried out in two municipalities of Antioquia: one with high rates of armed conflict and another with low rates. A total of 41 interviews and 8 focus groups were held with local and national government officials, health professionals, community informants, UN agencies and NGOs. Results: All of the indicators show improvement, however, four show statistically significant differences between municipalities with high victimization rates versus low ones. The maternal mortality ratio was higher in the municipalities with greater victimization in the periods 1998-2004, 2005-2011 and 2012-2016. The percentage of cesarean births and women who received four or more antenatal visits was lower among women who experienced the highest levels of victimization for the period 1998-2000, while the fertility rate for women between 15 and 19 years was higher in these municipalities between 2012 and 2016. In the context of the armed conflict in Colombia, maternal and child health was affected by the limited availability of interventions given the lack of human resources in health, supplies, geographical access difficulties and insecurity. The national government was the one that mostly provided the programs, with difficulties in continuity and quality. UN Agencies and NGOs accessed more easily remote and intense armed conflict areas. Few specific health interventions were identified in the postconflict context. Conclusions: In Colombia, maternal and child health indicators have improved since the conflict, however a pattern of inequality is observed in the municipalities most affected by the armed conflict.
Cervical cancer is considered to be a major health problem for women in developing countries, but it is also problematic for more developed countries as global migration increases and health behaviors move from the countries of origin to new places of residence. We designed and produced a testimonial video and a fotonovela (printed short story) to educate women about cervical cancer and screening. The development of the materials included formative research, production, pretesting, dissemination, and evaluation. The evaluation included 100 women that completed a pretest and a posttest at eight health clinics in Medellin. The pretest and posttest were analyzed using McNemar's test for categorical variables and paired t test for continuous variables. Women in the study had a high initial Stage of Change as defined by the Transtheoretical Model and a high baseline knowledge of HPV and cervical cancer, with the caveat of specific knowledge deficiencies especially for HPV. While not statistically significant, postintervention Transtheoretical Model status in both interventions changed towards higher stages, specifically, from Precontemplation to Contemplation and Preparation. Women who participated in the study liked the educational materials and their knowledge increased, especially for HPV. However, the perception of risk did not change.
The purpose of the study was to explore variables of the health belief model in relation to the follow-up of abnormal Pap smear among low-income women in Medellín, Colombia. Eight focus groups (62 women) were conducted according to age groups (25-45 and 46-69 years). The data were analyzed using content analysis. The participants perceived themselves as vulnerable, recognized the severity of the disease in terms of both its emotional and physical consequences, perceived the benefits of the follow-up, and mentioned cues to action, such as social support and the support of health entities. Perceived self-efficacy was compromised by health system barriers and by personal barriers, such as placing the needs of their children ahead of their own, fear, neglect, and the pain caused by the diagnostic and therapeutic procedures. Health education activities aimed at increasing the follow-up of abnormal Pap smears should consider psychological factors.
identificar barreras y facilitadores del seguimiento: diagnóstico y tratamiento de anormalidadescitológicas en mujeres de bajos ingresos usuarias de la red pública de servicios de salud de la ciudad deMedellín, Colombia. Métodos: se realizaron ocho grupos focales (62 mujeres) según grupos de edad (25-45y 46-69 años) y se hizo un análisis de contenido. Resultados: las barreras del sistema de salud reportadasfueron: a) barreras estructurales: fragmentación en la prestación del servicio, problemas con afiliaciones ycaracterísticas del régimen de afiliación; b) barreras administrativas: problemas y demoras en la asignaciónde citas, largas filas, problemas con autorizaciones y maltrato; y c) barreras económicas derivadas de lasdos anteriores y relacionadas con el gasto de bolsillo. También se mencionaron facilitadores estructurales yadministrativos. Conclusión: algunas características estructurales del sistema de salud y de la administraciónde las aseguradoras limitan el acceso de las mujeres al seguimiento de lesiones precancerosas.
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