Cardona-Arias Jaiberth Antonio, Salas-Zapata Walter Alfredo, Carmona-Fonseca Jaime
Universidad de Antioquia Universidad de Antioquia Escuela de Microbiología Medellín Colombia Escuela de Microbiología, Universidad de Antioquia, Medellín, Colombia.
Universidad de Antioquia Universidad de Antioquia Grupo Salud y Comunidad César Uribe Piedrahíta Medellín Colombia Grupo Salud y Comunidad César Uribe Piedrahíta, Universidad de Antioquia, Medellín, Colombia.
Rev Panam Salud Publica. 2019 Apr 17;43:e39. doi: 10.26633/RPSP.2019.39. eCollection 2019.
Describe how the 'social determination of health' approach has been applied in malaria studies around the world.
Systematic review of original studies published from 1980 to 2018. Six search strategies were used in ten multidisciplinary databases, and in libraries and repositories of seven universities in Brazil, Colombia, Ecuador, and Peru. PRISMA guidelines were followed, methodological quality was evaluated according to STROBE criteria, and a qualitative summary of the results was conducted.
Ten studies published from 1984 to 2017 met pre-established inclusion and exclusion criteria; 33 social determinants of malaria were identified. Of individual determinants, greater malaria risk was found in adults, people who are often outdoors at night, and people who do not take preventive measures; intermediate determinants were dwellings with poor physical and sanitary infrastructure, overcrowded, located in forested areas, and containing animals. Regarding socioeconomic determinants, the people at greatest risk were involved in agro-forestry activities, migrants, and those with low income and a low educational level. Malaria caused high economic losses and led to poverty and educational delay.
No studies were found that used Latin American social medicine approaches or that applied the World Health Organization's hierarchical and multilevel analysis for individual, intermediate, and structural determinants. No progress has been made in the analysis of social categories-territory, social class, gender, ethnic group, macroeconomic policies-or other socioeconomic characteristics that determine risk of illness or death from malaria.
描述“健康的社会决定因素”方法在全球疟疾研究中的应用方式。
对1980年至2018年发表的原始研究进行系统综述。在十个多学科数据库以及巴西、哥伦比亚、厄瓜多尔和秘鲁七所大学的图书馆及知识库中采用了六种检索策略。遵循PRISMA指南，根据STROBE标准评估方法学质量，并对结果进行定性总结。
1984年至2017年发表的十项研究符合预先设定的纳入和排除标准；确定了33个疟疾的社会决定因素。在个体决定因素方面，成年人、经常在夜间户外活动的人以及未采取预防措施的人感染疟疾的风险更高；中间决定因素包括物理和卫生基础设施差、拥挤、位于森林地区且有动物的住所。在社会经济决定因素方面，风险最高的人群包括从事农林业活动的人、移民以及低收入和低教育水平的人。疟疾造成了高昂的经济损失，并导致贫困和教育延迟。
未发现使用拉丁美洲社会医学方法或应用世界卫生组织针对个体、中间和结构决定因素的分层及多层次分析的研究。在分析决定疟疾疾病或死亡风险的社会类别——地域、社会阶层、性别、族群、宏观经济政策——或其他社会经济特征方面没有取得进展。
