Date of Award

January 2021

Document Type

Thesis

Degree Name

Master of Public Health (MPH)

Department

School of Public Health

First Advisor

Christian Tschudi

Abstract

The Colombian Conflict persisted for over 50 years, recently coming to an end in November 2016 after the signing of Colombia’s Peace Agreement between the government and FARC guerrilla group. Internal armed conflict is often entangled with the exacerbation of health outcomes, including promoting the spread of infectious diseases like cutaneous leishmaniasis (CL). CL is a vector-borne parasitic disease localized to the human tegument that decreases quality of life through lesions leading to scars and associated stigmatization. This study assessed changes in demographic and clinical characteristics of patients with CL in Southwest Colombia before and after the signing of the peace accord (January 1, 2013 – March 24, 2020). The date of signing –November 24, 2016– acts as a ‘natural/political intervention’, allowing for the delineation of 1397 patients with CL into Pre (n=650) and Post (n=747) cohorts. After comparing the Pre/Post patient profiles, significant differences were found in 7/9 key characteristics, and the median maximum lesion area significantly declined in 24/26 strata. It is evident that the Post-signing led to better CL outcomes for the population in this region; further, we present evidence that the Post-signing era compared to the Pre has led to consistently declined lesion areas among patients with CL. Overall, Post-peace accord positively impacted CL outcomes as freer travel and faster access to medical care appeared to increase as armed groups dispersed. Visualization of a density map allows observations of a shift in patients coming from the east, traveling farther for care. One major implication of this study is the potential to increase the use of local therapies versus more toxic antimonial (SbV) treatments. Future studies may shift to focus on the negative and unintended consequences of the peace-accord on CL; however, this study found that CL disease severity has improved in the immediate years following the signing of the peace accord compared to the years of violence prior.

Comments

This thesis is restricted to Yale network users only. It will be made publicly available on 06/01/2023

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