Inequalities in Health Care Attention of Severely Malnourished Children in Remote and Conflicts Zones

OBJECTIVES: To analyze geographical and social inequalities in the process of health care of Moderate and Severely Malnourished Children under two years old in remote and Conflicts Zone

METHODS: An ambispective (retrospective and prospective) analysis of the geographical, social context and clinical information using mixed methods was developed. The retrospective information was extracted from clinical records of children diagnosed with moderate and severely malnourished and attended in nine remote territories and with conflict problems in Colombia during the COVID-19 pandemic era in the period of 2020 and 2021. The prospective analysis was developed with interviews to health care professionals and mothers of children attended in 2021 and 2022 and external resources of epidemiological reports.

RESULTS: 357 clinical records of children diagnosed with acute moderate and severely malnourished were analyzed. 89% (320/357) of the population was located in the rural area, 76% of the children belong to indigenous ethnicity and 20% to afro-descendant, followed of migrants; more than a half of families have an income minor to 125 USD per month, on the other hand more than 500 newborns per month was attend at home. In the geographical analysis conflict and lack access roads were the most common circumstances identified as barrier to access to a specialized health care and factors relates with the food insecurity and clean water access. A high rotation of health care workers was also funded in that area.

CONCLUSIONS: The circumstances of poverty and inequities in that zones were increased after covid-19 pandemic and have a big influence in the health and nutrition status of children and their families. This situation requires new models of health care based on community surveillance and empowerment of leaders as midwives who are present in those territories. These results also highlight the need of intersectoral work in those areas.