CHALLENGE

The health problem to which this initiative responds is related to the effects of prenatal Zika virus infection on the child population. In Colombia, 356 cases of infants with microcephaly and other congenital defects (DC) of the central nervous system (CNS), associated with prenatal exposure to Zika, were confirmed; however, more than 18,000 children were exposed to the virus during their gestation.

The Zika virus epidemic between 2015 and 2016 In Colombia was the second largest in the Latin American Region, after Brazil.  Due to the emerging nature of ZIKV and the lack of knowledge about the natural history of this disease, the follow-up of symptomatic pregnant women and infants with a history of exposure to the virus became a priority for the Colombian health system.

INTERVENTION

Recommendations for the care and follow-up of pediatric patients with prenatal exposure to Zika virus is an initiative led by the Maternal and Perinatal Health Research group of the National Institute of Health of Colombia, following the Zika epidemic between 2015 and 2016. It emerged from three stages:

1. Case analysis: surveillance of microcephaly and congenital defects of the central nervous system.

In this first stage, the suspicious or confirmed cases are notified to an epidemiological database (Sivigila), the data is collected, field work is developed and samples are processed for study of ZIKV. The final report is deliver to departmental health secretariats.

2. Surveillance of Pregnant Women with Zika “VEZ”

Pregnant women are monitored, as well as birth and breastfeeding.

3. Monitoring of infants with prenatal exposure to ZIKV by a multidisciplinary team: Multidisciplinary clinical assessment, child development assessment, specialized examinations and collection of neuroimaging and electroencephalographic studies are performed.

IMPACT

The two-year follow-up of the children’s cohort made it possible to develop recommendations for the care and follow-up of paediatric patients with prenatal exposure to the Zika virus, which subsequently became public policy in Resolution 5857 of 2018, benefiting the entire Colombian population that required such services, especially children with greater functional commitment generated by this disease.

The greatest impact demonstrated in this population is related to the improvement of essential functions such as quality of sleep, improvement of nutritional status, improvement of motor function and control of complicated epilepsy, among others. In addition, insurance companies are aware of the children who are affiliated with their system with this condition, so lists have been generated for the special attention of these infants as well as for obtaining medical appointments with specialists, rehabilitation therapies, medications, and access to surgeries such as gastrostomies.

This approach between families in the stages of the Project, allowed the formation of two foundations, one in the city of Neiva called “Fundación Milagros de Dios – Niños del Zika” and “Fundación Ángeles sobre Ruedas”, in Barranquilla.

CASE INSIGHTS

Collaborative work between public and private institutions such as departmental and municipal health secretaries, the Colombian Red Cross, the Universidad del Norte, public and private hospitals in the participating cities, private companies, scientific societies and the Centers for Disease Control and Prevention in Atlanta was fundamental in monitoring the affected population.

Institutionality was really important to be able to manage public policies related to this disease.

The dialogue of professionals from different areas allowed us to obtain fundamental contributions in the construction of recommendations for the integral approach of these patients. As well as the participation of the community, since an effective dialogue was generated to understand their needs, problems and from there, the construction of recommendations according to their true realities.

Beyond health, it is important to integrate other sectors such as education and to understand that the solution proposed is dynamic since children develop different manifestations and complications throughout their lives.

VIEW CASE FILM

This video was filmed and produced by Chembe Collaborative.

EVIDENCE ABOUT THE INNOVATION