School of Microbiology, University of Antioquia, Medellín, Colombia.
Research group "Salud y Comunidad César Uribe Piedrahíta" School of Medicine, University of Antioquia, Medellín, Colombia.
BMC Public Health. 2023 Jun 17;23(1):1169. doi: 10.1186/s12889-023-16098-5.
Mixed methods are essential in public health research and malaria control, because they allow grasping part of the complexity and diversity of the factors that determine health-disease. This study analyzes the mixed studies on malaria in Colombia, 1980-2022, through a systematic review in 15 databases and institutional repositories. The methodological quality was assessed with Mixed Methods Appraisal Tool (MMAT), STrengthening the Reporting of OBservational studies in Epidemiology (STROBE), and Standards for Reporting Qualitative Research (SRQR). The qualitative and quantitative findings were grouped into a four-level hierarchical matrix. The epidemiological profile of malaria morbidity, from traditional epidemiology, has been sustained by environmental problems, armed conflict, individual risk behaviors, and low adherence to recommendations from health institutions. However, the qualitative component reveals deeper causes that are less studied, of greater theoretical complexity, and that reflect challenges to design and implement health interventions, such as socioeconomic and political crises, poverty, and the neoliberal orientation in the malaria control policy; the latter reflected in the change in the role of the State, the fragmentation of control actions, the predominance of insurance over social assistance, the privatization of the provision of health services, the individualistic and economistic predominance of health, and low connection with popular tradition and community initiatives. The above confirms the importance of expanding mixed studies as a source of evidence to improve malaria research and control models in Colombia, and to identify the underlying causes of the epidemiological profile.
混合方法在公共卫生研究和疟疾控制中至关重要，因为它们可以帮助理解决定健康-疾病的因素的部分复杂性和多样性。本研究通过在 15 个数据库和机构知识库中进行系统评价，分析了 1980 年至 2022 年哥伦比亚的混合研究。使用混合方法评估工具 (MMAT)、观察性研究的强化报告标准 (STROBE) 和定性研究报告标准 (SRQR) 评估方法学质量。将定性和定量发现分组到一个四级层次矩阵中。从传统流行病学角度看，疟疾发病率的流行病学特征一直受到环境问题、武装冲突、个体风险行为以及对卫生机构建议的低依从性的影响。然而，定性部分揭示了更深入的、研究较少的、理论上更复杂的原因，反映了设计和实施卫生干预措施的挑战，如社会经济和政治危机、贫困以及疟疾控制政策中的新自由主义倾向；后者反映在国家角色的变化、控制行动的碎片化、保险对社会援助的主导地位、卫生服务提供的私有化、健康的个人主义和经济主义主导地位以及与民间传统和社区倡议的低联系。上述情况证实了扩大混合研究作为证据来源的重要性，以改善哥伦比亚的疟疾研究和控制模式，并确定流行病学特征的根本原因。
