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Delivering maternal and childcare at primary healthcare level: The role of PMAQ as a pay for performance strategy in Brazil. PLoS One 2020; 15:e0240631. [PMID: 33057414 PMCID: PMC7561084 DOI: 10.1371/journal.pone.0240631] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Accepted: 09/29/2020] [Indexed: 11/23/2022] Open
Abstract
Background Improving access and quality in health care is a pressing issue worldwide and pay for performance (P4P) strategies have emerged as an alternative to enhance structure, process and outcomes in health. In 2011, Brazil adopted its first P4P scheme at national level, the National Programme for Improving Primary Care Access and Quality (PMAQ). The contribution of PMAQ in achieving the Sustainable Development Goals related to maternal and childcare remains under investigated in Brazil. Objective To estimate the association of PMAQ with the provision of maternal and childcare in Brazil, controlling for socioeconomic, geographic and family health team characteristics. Method We used cross-sectional quantile regression (QR) models for two periods, corresponding to 33,368 Family Health Teams (FHTs) in the first cycle and 39,211 FHTs in the second cycle of PMAQ. FHTs were analysed using data from the Brazilian Ministry of Health (SIAB and CNES) and the Brazilian Institute for Geography and Statistics (IBGE). Results The average number of antenatal consultations per month were positively associated with PMAQ participating teams, with larger effect in the lower tail (10th and 25th quantiles) of the conditional distribution of the response variable. There was a positive association between PMAQ and the average number of consultations under 2 years old per month in the 10th and 25th quantiles, but a negative association in the upper tail (75th and 90th quantiles). For the average number of physician consultations for children under 1 year old per month, PMAQ participating teams were positively associated with the response variable in the lower tail, but different from the previous models, there is no clear evidence that the second cycle gives larger coefficients compared with first cycle. Conclusion PMAQ has contributed to increase the provision of care to pregnant women and children under 2 years at primary healthcare level. Teams with lower average number of antenatal or child consultations benefited the most by participating in PMAQ, which suggests that PMAQ might motivate worse performing health providers to catch up.
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102
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Inequalities in infant mortality in Brazil at subnational levels in Brazil, 1990 to 2015. Popul Health Metr 2020; 18:4. [PMID: 32993802 PMCID: PMC7526088 DOI: 10.1186/s12963-020-00208-1] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2020] [Accepted: 06/19/2020] [Indexed: 01/13/2023] Open
Abstract
Background In this study, infant mortality rate (IMR) inequalities are analyzed from 1990 to 2015 in different geographic scales. Methods The Ministry of Health (MoH) IMR estimates by Federative Units (FU) were compared to those obtained by the Global Burden of Disease (GBD) group. In order to measure the inequalities of the IMR by FU, the ratios from highest to lowest from 1990 to 2015 were calculated. Maps were elaborated in 2000, 2010, and 2015 at the municipality level. To analyze the effect of income, IMR inequalities by GDP per capita were analyzed, comparing Brazil and the FU to other same-income level countries in 2015, and the IMR municipal estimates were analyzed by income deciles, in 2000 and 2010. Results IMR decreased from 47.1 to 13.4 per 1000 live births (LB) from 1990 to 2015, with an annual decrease rate of 4.9%. The decline was less pronounced for the early neonatal annual rate (3.5%). The Northeast region showed the most significant annual decline (6.2%). The IMR estimates carried out by the GBD were about 20% higher than those obtained by the MoH, but in terms of their inequalities, the ratio from the highest to the lowest IMR among the 27 FU decreased from 4 to 2, for both methods. The percentage of municipalities with IMR higher than 40 per 1000 LB decreased from 23% to 2%, between 2000 and 2015. Comparing the IMR distribution by income deciles, all inequality measures of the IMR decreased markedly from 2000 to 2010. Conclusion The results showed a marked decrease in the IMR inequalities in Brazil, regardless of the geographic breakdown and the calculation method. Despite clear signs of progress in curbing infant mortality, there are still challenges in reducing its level, such as the concentration of deaths in the early neonatal period, and the specific increases of post neonatal mortality in 2016, after the recent cuts in social investments.
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Machado DB, Pescarini JM, Ramos D, Teixeira R, Lozano R, Pereira VODM, Azeredo C, Paes-Sousa R, Malta DC, Barreto ML. Monitoring the progress of health-related sustainable development goals (SDGs) in Brazilian states using the Global Burden of Disease indicators. Popul Health Metr 2020; 18:7. [PMID: 32993666 PMCID: PMC7526114 DOI: 10.1186/s12963-020-00207-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2020] [Accepted: 06/19/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Measuring the Global Burden of Disease (GBD) has been the key to verifying the evolution of health indicators worldwide. We analyse subnational GBD data for Brazil in order to monitor the performance of the Brazilian states in the last 28 years on their progress towards meeting the health-related SDGs. METHODS As part of the GBD study, we assessed the 41 health-related indicators from the SDGs in Brazil at the subnational level for all the 26 Brazilian states and the Federal District from 1990 to 2017. The GBD group has rescaled all worldwide indicators from 0 to 100, assuming that for each one of them, the worst value among all countries and overtime is 0, and the best is 100. They also estimate the overall health-related SDG index as a function of all previously estimated health indicators and the SDI index (Socio-Demographic Index) as a function of per capita income, average schooling in the population aged 15 years or over, and total fertility rate under the age of 25 (TFU25). RESULTS From 1990 to 2017, most subnational health-related SDGs, the SDG and SDI indexes improved considerable in most Brazilian states. The observed differences in SDG indicators within Brazilian states, including HIV incidence and health worker density, increased over time. In 2017, health-related indicators that achieved good results globally included the prevalence of child wasting, NTD, household air pollution, conflict mortality, skilled birth attendance, use of modern contraceptive methods, vaccine coverage, and health worker density, but poor results were observed for child overweight and homicide rates. The high rates of overweight, alcohol consumption, and smoking prevalence found in the historically richest regions (i.e., the South and Southeast), contrast with the high rates of tuberculosis, maternal, neonatal, and under-5 mortality and WASH-related mortality found in the poorer regions (i.e., the North and Northeast). CONCLUSIONS The majority of Brazil's health-related SDG indicators have substantially improved over the past 28 years. However, inequalities in health among the Brazilian states and regions remain noticeable negatively affecting the Brazilian population, which can contribute to Brazil not achieving the SDG 2030 targets.
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Affiliation(s)
- Daiane Borges Machado
- Center of Data and Knowledge Integration for Health (Cidacs), Oswaldo Cruz Foundation, Salvador, Brazil.,Centre for Global Mental Health, London School of Hygiene & Tropical Medicine (LSHTM), London, UK
| | - Júlia Moreira Pescarini
- Center of Data and Knowledge Integration for Health (Cidacs), Oswaldo Cruz Foundation, Salvador, Brazil.
| | - Dandara Ramos
- Center of Data and Knowledge Integration for Health (Cidacs), Oswaldo Cruz Foundation, Salvador, Brazil.,Institute of Collective Health (ISC), Federal University of Bahia (UFBA), Salvador, Brazil
| | - Renato Teixeira
- Public Health Graduate Program, School of Medicine, Federal University of Minas Gerais, Belo Horizonte, Brazil
| | - Rafael Lozano
- School of Medicine, Institute for Health Metrics and Evaluation, University of Washington, Seattle, Washington, USA
| | | | - Cimar Azeredo
- Brazilian Institute of Geography and Statistics (IBGE), Rio de Janeiro, Brazil
| | | | - Deborah Carvalho Malta
- Escola de Enfermagem, Departamento Materno Infantil e Saúde Pública, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Mauricio L Barreto
- Center of Data and Knowledge Integration for Health (Cidacs), Oswaldo Cruz Foundation, Salvador, Brazil.,Institute of Collective Health (ISC), Federal University of Bahia (UFBA), Salvador, Brazil
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Souza RT, Vieira MC, Esteves-Pereira AP, Domingues RMSM, Moreira MEL, da Cunha Filho EV, Sandall J, Cecatti JG, do Carmo Leal M, Dias MAB, Pasupathy D. Risk stratification for small for gestational age for the Brazilian population: a secondary analysis of the Birth in Brazil study. Sci Rep 2020; 10:14725. [PMID: 32895438 PMCID: PMC7477559 DOI: 10.1038/s41598-020-71252-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2020] [Accepted: 07/27/2020] [Indexed: 11/09/2022] Open
Abstract
Risk-stratification screening for SGA has been proposed in high-income countries to prevent perinatal morbidity and mortality. There is paucity of data from middle-income settings. The aim of this study is to explore risk factors for SGA in Brazil and assess potential for risk stratification. This population-based study is a secondary analysis of Birth in Brazil study, conducted in 266 maternity units between 2011 and 2012. Univariate and multivariate logistic regressions were performed, and population attributable fraction estimated for early and all pregnancy factors. We calculated absolute risk, odds ratio, and population prevalence of single or combined factors stratified by parity. Factors associated with SGA were maternal lupus (ORadj 4.36, 95% CI [2.32-8.18]), hypertensive disorders in pregnancy (ORadj 2.72, 95% CI [2.28-3.24]), weight gain < 5 kg (ORadj 2.37, 95% CI [1.99-2.83]), smoking at late pregnancy (ORadj 2.04, 95% CI [1.60-2.59]), previous low birthweight (ORadj 2.22, 95% CI [1.79-2.75]), nulliparity (ORadj 1.81, 95% CI [1.60-2.05]), underweight (ORadj 1.61, 95% CI [1.36-1.92]) and socioeconomic status (SES) < 5th centile (ORadj 1.23, 95% CI [1.05-1.45]). Having two or more risk factors (prevalence of 4.4% and 8.0%) was associated with a 2 and fourfold increase in the risk for SGA in nulliparous and multiparous, respectively. Early and all pregnancy risk factors allow development of risk-stratification for SGA. Implementation of risk stratification coupled with specific strategies for reduction of risk and increased surveillance has the potential to contribute to the reduction of stillbirth in Brazil through increased detection of SGA, appropriate management and timely delivery.
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Affiliation(s)
- Renato T Souza
- Department of Obstetrics and Gynaecology, School of Medical Sciences, University of Campinas (UNICAMP), 101 Alexander Fleming St, Cidade Universitaria, Campinas, SP, Brazil
| | - Matias C Vieira
- Department of Obstetrics and Gynaecology, School of Medical Sciences, University of Campinas (UNICAMP), 101 Alexander Fleming St, Cidade Universitaria, Campinas, SP, Brazil
- Department of Women and Children's Health, School of Life Course Sciences, Faculty of Life Sciences and Medicine, King's College London, Women's Health Academic Centre KHP, 10th Floor North Wing, St. Thomas' Hospital, Westminster Bridge Road, London, SE1 7EH, UK
- Department of Obstetrics and Gynaecology, São Lucas Hospital, School of Medicine, Pontifical Catholic University of Rio Grande Do Sul, 6690 Ipiranga Avenue, Porto Alegre, RS, Brazil
| | - Ana Paula Esteves-Pereira
- National School of Public Health, Oswaldo Cruz Foundation/FIOCRUZ, 1480 Leopoldo Bulhoes St, Manguinhos, Rio de Janeiro, RJ, Brazil
| | | | - Maria Elisabeth Lopes Moreira
- Department of Neonatology, Fernandes Figueira Institute, Oswaldo Cruz Foundation/FIOCRUZ, 716 Rui Barbosa st, Flamengo, Rio de Janeiro, Brazil
| | - Edson Vieira da Cunha Filho
- Department of Obstetrics and Gynaecology, São Lucas Hospital, School of Medicine, Pontifical Catholic University of Rio Grande Do Sul, 6690 Ipiranga Avenue, Porto Alegre, RS, Brazil
| | - Jane Sandall
- Department of Women and Children's Health, School of Life Course Sciences, Faculty of Life Sciences and Medicine, King's College London, Women's Health Academic Centre KHP, 10th Floor North Wing, St. Thomas' Hospital, Westminster Bridge Road, London, SE1 7EH, UK
| | - Jose G Cecatti
- Department of Obstetrics and Gynaecology, School of Medical Sciences, University of Campinas (UNICAMP), 101 Alexander Fleming St, Cidade Universitaria, Campinas, SP, Brazil
| | - Maria do Carmo Leal
- National School of Public Health, Oswaldo Cruz Foundation/FIOCRUZ, 1480 Leopoldo Bulhoes St, Manguinhos, Rio de Janeiro, RJ, Brazil
| | - Marcos Augusto Bastos Dias
- Fernandes Figueira Institute, Oswaldo Cruz Foundation/FIOCRUZ, 716 Rui Barbosa st, Flamengo, Rio de Janeiro, Brazil
| | - Dharmintra Pasupathy
- Department of Women and Children's Health, School of Life Course Sciences, Faculty of Life Sciences and Medicine, King's College London, Women's Health Academic Centre KHP, 10th Floor North Wing, St. Thomas' Hospital, Westminster Bridge Road, London, SE1 7EH, UK.
- Discipline of Obstetrics, Gynaecology and Neonatology, Westmead Clinical School, University of Sydney, Sydney, NSW, 2145, Australia.
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105
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Soares RAS, Moraes RMD, Vianna RPDT. [Infant mortality in the Brazilian countryside: a proposal to overcome epidemiological and demographic invisibility]. CAD SAUDE PUBLICA 2020; 36:e00068718. [PMID: 32901701 DOI: 10.1590/0102-311x00068718] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2018] [Accepted: 01/31/2020] [Indexed: 11/21/2022] Open
Abstract
The study aimed to compare two concepts of rurality, one proposed by the Brazilian Institute of Geography and Statistics (IBGE) and the other by the World Bank, to determine which is better fitted to the territory's reality, besides analyzing the infant mortality profile of rural municipalities (counties) in the state of Paraíba, Brazil, according to the best criterion for rurality. This was an observational epidemiological study conducted in the state of Paraíba. The method for analyzing rural/urban typologies was based on data mining, using the Apriori algorithm of association. Infant mortality was analyzed with descriptive statistics. The data were obtained from the Mortality Information System of the Brazilian Ministry of Health, from 2007 to 2016, and municipal indicators were from IBGE. The World Bank definition of rurality showed kappa = 0.337, compared to the IBGE definition, with kappa = 0.616. Among the 223 municipalities that were analyzed, the World Bank classified 130 (65.66%) correctly, and the IBGE 183 (82.06%). The predominant epidemiological profile of infant mortality in rural municipalities in Paraiba state was male gender (57.4%), brown skin color (61.1%), age from 0 to 7 days (52.4%), low birthweight (44%), and gestational age less than 37 weeks (43.2%). Underlying cause of death was classified as avoidable death via interventions by the Brazilian Unified National Health System (65.2%). The urban/rural typology adopted by the IBGE was better than the World Bank at classifying the municipalities in Paraiba state. This classification allowed studying the infant mortality profile in rural municipalities, which was similar to the overall profile, except for maternal schooling.
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Affiliation(s)
| | - Ronei Marcos de Moraes
- Programa de Pós-graduação em Modelos de Decisão e Saúde, Universidade Federal da Paraíba, João Pessoa, Brasil
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Silva GS, Fernandes DDRF, Alves CRL. Avaliação da assistência à saúde da criança na Atenção Primária no Brasil: revisão sistemática de métodos e resultados. CIENCIA & SAUDE COLETIVA 2020; 25:3185-3200. [DOI: 10.1590/1413-81232020258.27512018] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2018] [Accepted: 11/27/2018] [Indexed: 11/21/2022] Open
Abstract
Resumo Essa revisão sistemática objetivou analisar os métodos e instrumentos, bem como os principais resultados, das avaliações de qualidade da assistência à saúde da criança na APS no Brasil. Estudo realizado de acordo com as recomendações do Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA), em consulta às bases de dados MEDLINE, LILACS, IBECS e BDENF, PUBMED, PsycNET, Cochrane e CINAHL (1994-2016), com foco em crianças de 0 a 5 anos. Foram identificados 3.004 artigos. Após a triagem inicial e a aplicação dos critérios STROBE e SRQR, 21 artigos foram incluídos na revisão. Cerca de 52% dos artigos foram realizados na região sudeste e 95,2% publicados a partir de 2010. O principal instrumento de avaliação utilizado foi o Primary Care Assessment Tool (52,4%). A qualidade da assistência a criança mostrou-se deficitária, com limitações no acesso aos serviços, carência de infraestrutura e baixa qualificação de profissionais. Houve aumento significativo dos estudos avaliativos nos últimos anos no Brasil. Apesar dos avanços na assistência à saúde no país, os limitados índices de qualidade apontam a necessidade de superação de desafios para garantia da atenção integral à saúde da criança.
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107
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Garnelo L, Parente RCP, Puchiarelli MLR, Correia PC, Torres MV, Herkrath FJ. Barriers to access and organization of primary health care services for rural riverside populations in the Amazon. Int J Equity Health 2020; 19:54. [PMID: 32731874 PMCID: PMC7394681 DOI: 10.1186/s12939-020-01171-x] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2019] [Accepted: 04/07/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The ways of life in the Amazon are diverse and not widely known. In addition, social inequities, large geographic distances and inadequate health care network noticeably limit access to health services in rural areas. Over the last decades, Brazilian health authorities have implemented fluvial mobile units (FMU) as an alternative to increase access and healthcare coverage. The aim of the study was to identify the strategies of access and utilization of primary health care (PHC) services by assessing the strengths and limitations of the healthcare model offered by the FMU to reduce barriers to services and ensure the right to healthcare. METHODS Qualitative and ethnographic research involving participant observation and semi-structured interviews. Data collection consisted of interviews with users and health professionals and the observation of service organization and healthcare delivered by the FMU, in addition to the therapeutic itineraries that determine demand, access and interaction of users with healthcare services. RESULTS Primary care is offered by the monthly locomotion of the FMU that serves approximately 20 rural riverside communities. The effectiveness of the actions of the FMU proved to be adequate for conditions such as antenatal care for low-risk pregnancy, which require periodic consultations. However, conditions that require continued attention are not adequately met through the organization of care established in the FMU. The underutilization of the workforce of community health workers and disarrangement between their tasks and those of the rest of the multi-professional team are some of the reasons pointed out, making the healthcare continuity unfeasible within the intervals between the trips of the FMU. From the users' perspective, although the presence of the FMU provides healthcare coverage, the financial burden generated by the pursuit for services persists, since the dispersed housing pattern requires the locomotion of users to reach the mobile unit services as well as for specialized care in the urban centers. CONCLUSIONS The implementation of the FMU represents an advance in terms of accessibility to PHC. However, the organization of their activity uncritically replicates the routines adopted in the daily routine of health services located in urban spaces, proving to be inadequate for providing healthcare strategies capable of mitigating social and health inequalities faced by the users.
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Affiliation(s)
- Luiza Garnelo
- Instituto Leônidas e Maria Deane, Fundação Oswaldo Cruz, Rua Teresina, 476, Adrianópolis, Manaus, Amazonas, 69057-070, Brazil
- Programa de Pós-Graduação em Condições de Vida e Situações de Saúde na Amazônia, Instituto Leônidas e Maria Deane, Fundação Oswaldo Cruz, Rua Teresina, 476, Adrianópolis, Manaus, Amazonas, 69057-070, Brazil
| | - Rosana Cristina Pereira Parente
- Instituto Leônidas e Maria Deane, Fundação Oswaldo Cruz, Rua Teresina, 476, Adrianópolis, Manaus, Amazonas, 69057-070, Brazil
- Programa de Pós-Graduação em Condições de Vida e Situações de Saúde na Amazônia, Instituto Leônidas e Maria Deane, Fundação Oswaldo Cruz, Rua Teresina, 476, Adrianópolis, Manaus, Amazonas, 69057-070, Brazil
| | - Maria Laura Rezende Puchiarelli
- Programa de Pós-Graduação em Condições de Vida e Situações de Saúde na Amazônia, Instituto Leônidas e Maria Deane, Fundação Oswaldo Cruz, Rua Teresina, 476, Adrianópolis, Manaus, Amazonas, 69057-070, Brazil
| | - Priscilla Cabral Correia
- Programa de Pós-Graduação em Condições de Vida e Situações de Saúde na Amazônia, Instituto Leônidas e Maria Deane, Fundação Oswaldo Cruz, Rua Teresina, 476, Adrianópolis, Manaus, Amazonas, 69057-070, Brazil
| | - Matheus Vasconcelos Torres
- Programa de Pós-Graduação em Condições de Vida e Situações de Saúde na Amazônia, Instituto Leônidas e Maria Deane, Fundação Oswaldo Cruz, Rua Teresina, 476, Adrianópolis, Manaus, Amazonas, 69057-070, Brazil
| | - Fernando José Herkrath
- Instituto Leônidas e Maria Deane, Fundação Oswaldo Cruz, Rua Teresina, 476, Adrianópolis, Manaus, Amazonas, 69057-070, Brazil.
- Programa de Pós-Graduação em Condições de Vida e Situações de Saúde na Amazônia, Instituto Leônidas e Maria Deane, Fundação Oswaldo Cruz, Rua Teresina, 476, Adrianópolis, Manaus, Amazonas, 69057-070, Brazil.
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Silva TPRD, Dumont-Pena E, Moreira AD, Camargos BA, Meireles MQ, Souza KVD, Matozinhos FP. Factors associated with normal and cesarean delivery in public and private maternity hospitals: a cross-sectional study. Rev Bras Enferm 2020; 73 Suppl 4:e20180996. [PMID: 32756742 DOI: 10.1590/0034-7167-2018-0996] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2019] [Accepted: 01/04/2020] [Indexed: 12/16/2022] Open
Abstract
OBJECTIVES to investigate the factors associated with the mode of delivery in pregnant women in the city of Belo Horizonte. METHODS cross-sectional study developed with data from the study "Being born in Belo Horizonte: survey on childbirth and birth" carried out in seven maternity hospitals in Belo Horizonte - Minas Gerais. The final sample consisted of 1088 pregnant/postpartum women. In this study, to verify the magnitude of the association between the outcome variable and its possible determinants (exposure variables) logistic regression models were constructed to estimate the Odds Ratio. RESULTS increasing age, the lack of companionship, the hospital's private financing for performing delivery and being a first-time pregnant woman increased the chance of delivery by cesarean section. Final Considerations: the knowledge of factors associated with the prevalence of cesarean sections can support reflections among health professionals about this surgical procedure in certain situations, especially when there are no precise clinical indications.
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Affiliation(s)
| | - Erica Dumont-Pena
- Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
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109
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Fatori D, Argeu A, Brentani H, Chiesa A, Fracolli L, Matijasevich A, Miguel EC, Polanczyk G. Maternal Parenting Electronic Diary in the Context of a Home Visit Intervention for Adolescent Mothers in an Urban Deprived Area of São Paulo, Brazil: Randomized Controlled Trial. JMIR Mhealth Uhealth 2020; 8:e13686. [PMID: 32720906 PMCID: PMC7420524 DOI: 10.2196/13686] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2019] [Revised: 11/27/2019] [Accepted: 02/07/2020] [Indexed: 01/29/2023] Open
Abstract
BACKGROUND Pregnancy during adolescence is prevalent in low- and middle-income countries (LMICs), which is associated with various adverse outcomes that can be prevented with home visiting programs. However, testing these interventions in LMICs can be challenging due to limited resources. The use of electronic data collection via smartphones can be an alternative and ideal low-cost method to measure outcomes in an environment with adverse conditions. OBJECTIVE Our study had two objectives: to test the efficacy of a nurse home visiting intervention on maternal parenting and well-being measured by an electronic daily diary (eDiary), and to investigate the compliance rate of the eDiary measurement method. METHODS We conducted a randomized controlled trial to test the efficacy of Primeiros Laços, a nurse home visiting program, for adolescent mothers living in an urban deprived area of São Paulo, Brazil. A total of 169 pregnant adolescents were assessed for eligibility criteria, 80 of whom were included and randomized to the intervention (n=40) and control group (care as usual, n=40). Primeiros Laços is a home visiting intervention delivered by trained nurses tailored to first-time pregnant adolescents and their children, starting during the first 16 weeks of pregnancy until the child reaches 24 months of age. Participants were assessed by blind interviewers at 8-16 weeks of pregnancy (baseline), 30 weeks of pregnancy, and when the child was 3, 6, and 12 months of age. At 18 months, participants were assessed regarding maternal parenting and parental well-being using a 7-consecutive-day eDiary. The smartphone app was programmed to notify participants every day at 9:00 PM over a period of seven days. RESULTS We were able to contact 57/80 (71%) participants (29 from the intervention group and 28 from the control group) when the child was 18 months of age. Forty-eight of the 57 participants (84%) completed at least one day of the eDiary protocol. The daily compliance rate ranged from 49% to 70%. Our analyses showed a significant effect of the intervention on parental well-being (B=0.32, 95% CI [0.06, 0.58], P=.02) and the maternal parenting behavior of the mother telling a story or singing to the child (odds ratio=2.33, 95% CI [1.20, 4.50], P=.01).Our analyses showed a significant effect of the intervention on parental well-being (B=0.32, P=.02) and the maternal parenting behavior of the mother telling a story or singing to the child (odds ratio=2.33, P=.01). CONCLUSIONS The Primeiros Laços intervention improved maternal parenting and parental well-being, demonstrating its promise for low-income adolescent mothers. The compliance rate of the eDiary assessment showed that it was generally accepted by adolescent mothers with limited resources. Future studies can implement ambulatory assessment in LMICs via smartphones to measure mother and child behaviors. TRIAL REGISTRATION ClinicalTrials.gov NCT02807818; https://clinicaltrials.gov/ct2/show/NCT02807818.
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Affiliation(s)
- Daniel Fatori
- Department of Psychiatry, University of Sao Paulo Medical School, Sao Paulo, Brazil
| | - Adriana Argeu
- Department of Psychiatry, University of Sao Paulo Medical School, Sao Paulo, Brazil
| | - Helena Brentani
- Department of Psychiatry, University of Sao Paulo Medical School, Sao Paulo, Brazil
| | - Anna Chiesa
- Collective Health Nursing Department, School of Nursing, University of Sao Paulo, Sao Paulo, Brazil
| | - Lislaine Fracolli
- Collective Health Nursing Department, School of Nursing, University of Sao Paulo, Sao Paulo, Brazil
| | - Alicia Matijasevich
- Department of Preventive Medicine, University of Sao Paulo Medical School, Sao Paulo, Brazil
| | - Euripedes C Miguel
- Department of Psychiatry, University of Sao Paulo Medical School, Sao Paulo, Brazil
| | - Guilherme Polanczyk
- Department of Psychiatry, University of Sao Paulo Medical School, Sao Paulo, Brazil
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Zhou M, Zhang L, Hu N, Kuang L. Association of primary care physician supply with maternal and child health in China: a national panel dataset, 2012-2017. BMC Public Health 2020; 20:1093. [PMID: 32652971 PMCID: PMC7353716 DOI: 10.1186/s12889-020-09220-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2019] [Accepted: 07/06/2020] [Indexed: 12/04/2022] Open
Abstract
Background The Chinese government has been strengthening the primary care system since the launch of the New Healthcare System Reform in 2009. Among all endeavors, the most obvious and significant improvement lays in maternal and child health. This study was designed to explore the association of primary care physician supply with maternal and child health outcomes in China, and provide policy suggestions to the law makers. Methods Six-year panel dataset of 31 provinces in China from 2012 to 2017 was used to conduct the longitudinal ecological study. Linear fixed effects regression model was applied to explore the association of primary care physician supply with the metrics of maternal and child health outcomes while controlling for specialty care physician supply and socio-economic covariates. Stratified analysis was used to test whether this association varies across different regions in China. Results The number of primary care physicians per 10,000 population increased from 15.56 (95% CI: 13.66 to 17.47) to 16.08 (95% CI: 13.86 to 18.29) from 2012 to 2017. The increase of one primary care physician per 10,000 population was associated with 5.26 reduction in maternal mortality per 100,000 live births (95% CI: − 6.745 to − 3.774), 0.106% (95% CI: − 0.189 to − 0.023) decrease in low birth weight, and 0.419 decline (95% CI: − 0.564 to − 0.273) in perinatal mortality per 1000 live births while other variables were held constant. The association was particularly prominent in the less-developed western China compared to the developed eastern and central China. Conclusion The sufficient supply of primary care physician was associated with improved maternal and child health outcomes in China, especially in the less-developed western region. Policies on effective and proportional allocation of resources should be made and conducted to strengthen primary care system and eliminate geographical disparities.
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Affiliation(s)
- Mengping Zhou
- Department of Health Administration, School of Public Health, Sun Yat-sen University, No.74, Zhong Shan Er Road, Guangzhou, 510080, China
| | - Luwen Zhang
- Department of Health Management, School of Health Services Management, Southern Medical University, Guangzhou, 510515, China
| | - Nan Hu
- Department of Biostatistics, FIU Robert Stempel College of Public Health and Social Work, Miami, FL, 33199, USA.,Department of Family and Preventive Medicine, and Population Health Sciences, University of Utah School of Medicine, Salt Lake City, UT, 84132, USA
| | - Li Kuang
- Department of Health Administration, School of Public Health, Sun Yat-sen University, No.74, Zhong Shan Er Road, Guangzhou, 510080, China.
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111
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Sinharoy SS, Clasen T, Martorell R. Air pollution and stunting: a missing link? LANCET GLOBAL HEALTH 2020; 8:e472-e475. [PMID: 32199113 PMCID: PMC8202973 DOI: 10.1016/s2214-109x(20)30063-2] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/15/2019] [Revised: 02/10/2020] [Accepted: 02/13/2020] [Indexed: 01/16/2023]
Affiliation(s)
- Sheela S Sinharoy
- Gangarosa Department of Environmental Health, Rollins School of Public Health, Emory University, Atlanta, GA 30322, USA.
| | - Thomas Clasen
- Gangarosa Department of Environmental Health, Rollins School of Public Health, Emory University, Atlanta, GA 30322, USA
| | - Reynaldo Martorell
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA 30322, USA
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Costa JC, Maia MFS, Victora CG. Ciência & Saúde Coletiva - 25 years: contributions to pregnancy, delivery, and childhood studies. CIENCIA & SAUDE COLETIVA 2020; 25:4813-4830. [PMID: 33295503 DOI: 10.1590/1413-812320202512.21642020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Accepted: 06/24/2020] [Indexed: 11/22/2022] Open
Abstract
We reviewed the scientific production on maternal health and the health of children under ten years of age, published in Journal Ciência & Saúde Coletiva during the last 25 years, focusing on quantitative studies. The authors' characteristics, populations under study, thematic areas, and methodology are described. A total of 170 publications were identified and grouped into 12 major themes. Pregnancy, delivery, and puerperium were the subject of 47 studies, followed by child anthropometric assessments (29), breastfeeding (24), and mortality (13). The selected publications represented 3.5% of the total original papers published by the Journal since its creation in 1996 and about 5% of the publications in the 2015-2020 period. The primary data sources were health service records, information systems, and population surveys. The cross-sectional design was used in 113 of the 170 articles, and 70% covered only one municipality. The Southeast and Northeast Regions of Brazil were the target of most studies, and the North Region was the least represented. The publications reflect the complexity of maternal and child health themes, with a particular focus on the importance of the Unified Health System and showing how open access data can contribute to public health research.
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Affiliation(s)
- Janaína Calu Costa
- Centro Internacional de Equidade em Saúde, Programa de Pós-Graduação em Epidemiologia, Universidade Federal de Pelotas. R. Marechal Deodoro 1160, Centro. 96020-220 Pelotas RS Brasil.
| | - Maria Fatima Santos Maia
- Centro Internacional de Equidade em Saúde, Programa de Pós-Graduação em Epidemiologia, Universidade Federal de Pelotas. R. Marechal Deodoro 1160, Centro. 96020-220 Pelotas RS Brasil.
| | - Cesar Gomes Victora
- Centro Internacional de Equidade em Saúde, Programa de Pós-Graduação em Epidemiologia, Universidade Federal de Pelotas. R. Marechal Deodoro 1160, Centro. 96020-220 Pelotas RS Brasil.
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Ogawa L, Shimoda GT, Wei CY, Püschel VADA. Prevention and management of primary postpartum hemorrhage among puerperae in a teaching hospital in São Paulo, Brazil: a best practice implementation project. ACTA ACUST UNITED AC 2020; 17:414-428. [PMID: 30870332 DOI: 10.11124/jbisrir-2017-003830] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
OBJECTIVES The aim of this project was to develop and implement strategies to promote standardization and formal documentation of increased bleeding within the first 24 h after birth, in compliance with best practice. INTRODUCTION Official data from Brazil shows a maternal mortality rate of around 52 to 75 deaths per 100,000 live births, 8% of which are caused by hemorrhage. Early diagnosis is promoted through standardization and formal documentation of the first signs of hemorrhage. METHODS The current implementation project used the Joanna Briggs Institute Practical Application of Clinical Evidence System, a baseline audit was conducted on a sample size of 108 patients and 67 nursing staff. Based on the results of the baseline audit, strategies to address non-compliance were developed and implemented. A follow-up audit was conducted on a sample size of 110 patients and 68 nursing staff, using the same audit criteria. RESULTS The baseline audit showed poor compliance with evidence-based best practice in every criterion. The implemented protocol for postpartum hemorrhage was well received by the nursing staff, promoting early diagnosis of increased bleeding within 24 h after birth and providing support for further medical treatment. There were significant improvements in every best practice criterion in the follow-up audit. CONCLUSION The current implementation project managed to improve the nursing staff professional practice, reducing the absence of records while promoting greater awareness of the first signs of primary postpartum hemorrhage.
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Affiliation(s)
- Luciana Ogawa
- University Hospital, University of São Paulo, São Paulo, Brazil
| | - Gilcéria Tochika Shimoda
- University Hospital, University of São Paulo, São Paulo, Brazil.,The Brazilian Centre for Evidence-informed Healthcare: a Joanna Briggs Institute Centre of Excellence, São Paulo, Brazil
| | - Chang Yi Wei
- University Hospital, University of São Paulo, São Paulo, Brazil
| | - Vilanice Alves de Araújo Püschel
- The Brazilian Centre for Evidence-informed Healthcare: a Joanna Briggs Institute Centre of Excellence, São Paulo, Brazil.,School of Nursing, University of São Paulo, São Paulo, Brazil
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[Health inequalities: new theoretical perspectives]. Salud Colect 2020; 16:e2751. [PMID: 32574463 DOI: 10.18294/sc.2020.2751] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2020] [Accepted: 06/13/2020] [Indexed: 11/24/2022] Open
Abstract
This article, I intend to articulate the theoretical problem of economic and social inequalities with the issue of the social determination of health. Initially, I provide a summary of Rawls' and Sen's theories of justice and equity as an illustration of the dominant perspective in Northern epistemologies. Second, I discuss applications of this theoretical framework in the literature on social inequalities and the social determination of health-illness-care. Thirdly, I present a semantic matrix proposed for the difference-distinction-inequality-inequity-iniquity series to help reduce the existing terminological confusion. Next, I introduce a synthetic theoretical model about the poverty-inequality dyad, referring to the concepts of social resources, health practices, health services, and health situation/conditions. Finally, oriented by an epistemological perspective from the global South, and taking the current Brazilian situation as a case study, I discuss political implications of the complex contemporary conjuncture, pertinent to the hypothesis that a process of transformation of economic inequalities into new forms of social inequities and health iniquities is currently underway.
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Oliveira KRVD, Santos AAPD, Silva JMDOE, Sanches METDL, Albuquerque JDM, Moraes MMD. Health behaviors in sexual experiences of women in prison. Rev Bras Enferm 2020; 72:88-95. [PMID: 31851239 DOI: 10.1590/0034-7167-2018-0092] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2018] [Accepted: 06/11/2018] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE to describe the health behaviors related to the sexual experiences of women in the female prison system from January to March, 2017. METHOD descriptive study with a qualitative approach. A semi-structured questionnaire containing mixed questions and patient records was used. The data analysis was performed through the Bardin's content analysis and adopted as reference the Theory of Basic Human Needs. RESULTS 18 women, young, single, brown, with a complete fundamental level participated in the study. After this characterization, two categories were evidenced: Health behaviors in sexual experiences and Health care in the face of sexual experiences. 33.3% reported on health behaviors such as Sexually Transmitted Infections (STIs), 27.7% associated with male condom use, 16.6% on prevention of unwanted pregnancies, 11.1% on health care and hygiene. FINAL CONSIDERATIONS it was evidenced that the health behaviors reported by women in sexual experiences are associated with actions to prevent STIs, use of condoms, unwanted pregnancies, and health and hygiene care. However, it is possible to infer that they understand and possess superficial knowledge about health behaviors and that there is no adoption of regular practice in their sexual experiences.
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Rocha ÉMB, Lopes AF, Pereira SM, Leone C, Abreu LCD, Vieira PD, Szarfarc SC. IRON DEFICIENCY ANEMIA AND ITS RELATIONSHIP WITH SOCIOECONOMIC VULNERABILITY. ACTA ACUST UNITED AC 2020; 38:e2019031. [PMID: 32520297 PMCID: PMC7274531 DOI: 10.1590/1984-0462/2020/38/2019031] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2019] [Accepted: 05/14/2019] [Indexed: 11/22/2022]
Abstract
Objective: To analyze the association of anemia with the socioeconomic vulnerability of preschoolers in public day care centers, in the city of Taubaté, SP, Brazil. Methods: This is a cross-sectional study with a probabilistic sample that analyzed 363 children assisted in public day care centres in low-income and high-income areas of Taubaté, SP, Brazil. The hemoglobin concentration (Hb), dependent variable, was obtained by digital puncture, considering anemic children with Hb concentration <11.0 g/dL. The independent variables such as socioeconomic and demographic conditions were collected by a semi-structured questionnaire. Results: The prevalence of iron deficiency anemia was 19.3% among preschoolers. Children from day care centers with high socioeconomic vulnerability had lower Hb concentration than those from a non-vulnerable area (p<0.05). Conclusions: The lower concentration of hemoglobin in preschoolers is associated with the location of day care centers in an area of socioeconomic vulnerability. Children attending these day care centers face adverse family conditions such as low income, working mothers, and mothers with low schooling, though they receive social benefits and monitoring by public health services.
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Affiliation(s)
| | - Amanda Forster Lopes
- Institute of Health and Biotechnology, Universidade Federal do Amazonas, Coari, AM, Brazil
| | - Silvia Maira Pereira
- Department of Nursing and Nutrition, Universidade de Taubaté, Taubaté, SP, Brazil
| | - Claudio Leone
- School of Public Health, Universidade de São Paulo, São Paulo, SP, Brazil
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117
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Preconception nutrition: building advocacy and social movements to stimulate action. J Dev Orig Health Dis 2020; 12:141-146. [PMID: 32419689 DOI: 10.1017/s2040174420000197] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Action to improve preconception nutrition is a collective, societal responsibility. We believe that the Developmental Origins of Health and Disease (DOHaD) society is ideally placed to facilitate the development of a global agenda for preconception nutrition which recognises the societal importance of nutrition for young women and men, and supports them in optimising their nutritional status for the benefit of the next generation. In this paper, we outline four key actions that can be taken by the members of DOHaD's international society located across 67 countries, and nine regional societies, to demonstrate this leadership role. The recommended actions to place preconception nutrition at the top of national and regional agendas include (i) continuing to build the scientific evidence, (ii) monitoring of progress made by governments and commercial companies, (iii) developing advocacy coalitions that unite individuals and organisations around common policy options and (iv) working with partners to develop an emotive and empowering preconception nutrition awareness campaign. Collectively, these actions hold the potential to develop into a preconception nutrition social movement to invoke high-level government support and across-sector policy action, while raising public demand for action and engaging corporate actors.
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Fernandes CSE, Lima MG, Barros MBDA. Emotional problems and the use of psychotropic drugs: investigating racial inequality. CIENCIA & SAUDE COLETIVA 2020; 25:1677-1688. [PMID: 32402020 DOI: 10.1590/1413-81232020255.33362019] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2019] [Accepted: 08/07/2019] [Indexed: 01/08/2023] Open
Abstract
The aim of the present study was to investigate the existence of racial inequalities in the prevalence of emotional problems, the search for healthcare services and the use of psychotropic drugs. A population-based, cross-sectional study was conducted with data from the 2014/15 Campinas Health Survey. Sample of 1953 individuals aged 20 years or older was analyzed. We estimated the prevalence of common mental disorders (CMDs), the reporting of emotional problems, insomnia, the search for and the use of healthcare services and the use of psychotropic drugs according to self-reported skin color (white and black/brown). Prevalence ratios were estimated using "Poisson" multiple regression. The prevalence of CMDs was higher among blacks/brown compared to whites but no difference was found regarding the reporting of emotional problems and insomnia. Whites sought healthcare services more due to emotional problems. The use of psychotropic drugs was also higher among whites. The results revealed racial inequalities in the presence of CMDs, the search for healthcare services and the use of psychotropics drugs, highlighting the need for actions to identify and overcome barriers that hinder access to mental health care by different racial segments of the population.
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Affiliation(s)
| | - Margareth Guimarães Lima
- Departamento de Saúde Coletiva, Faculdade de Ciências Médicas, Universidade Estadual de Campinas, Campinas, SP, Brazil,
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Anderson EJ, Ernst KC, Martins FF, Martins CDS, Koss MP. Women's Health Perceptions and Beliefs Related to Zika Virus Exposure during the 2016 Outbreak in Northern Brazil. Am J Trop Med Hyg 2020; 102:629-633. [PMID: 31933455 DOI: 10.4269/ajtmh.19-0311] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
During the 2016 Zika pandemic in Brazil, women's perceptions of infection risk, ability to adhere to Zika prevention strategies, or access to services following exposure were not emphasized in the public health response. Women in Fortaleza, Brazil, responded to a questionnaire on social factors related to perceived Zika risk and access to health care in June 2016. Data were coded using prespecified categories, and response frequency was reported. Of 37 respondents, most reported a lack of public services to support mosquito control (n = 19) or delayed access to reproductive health care (n = 14). Only 22% described specific maternal risks or fetal outcomes as a consequence of Zika infection. Respondents indicated an overall disconnect between public health efforts and women's perceptions of their reproductive control, including limited support concerning microcephaly in infants. Interventions targeting Zika may require a greater emphasis on strengthening health systems and infrastructure to realistically prevent transmission.
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Affiliation(s)
| | - Kacey C Ernst
- Department of Epidemiology and Biostatistics, University of Arizona, Tucson, Arizona
| | | | | | - Mary P Koss
- Department of Health Promotion Sciences, University of Arizona, Tucson, Arizona
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120
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Fertility outcomes of IVF/ICSI after Caesarean section: a cohort study. Reprod Biomed Online 2020; 40:719-728. [DOI: 10.1016/j.rbmo.2019.12.004] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2019] [Revised: 12/01/2019] [Accepted: 12/10/2019] [Indexed: 12/28/2022]
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121
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Victora JD, Silveira MF, Tonial CT, Victora CG, Barros FC, Horta BL, Santos ISD, Bassani DG, Garcia PCR, Scheeren M, Fiori HH, Matijasevich A, Barros AJ, Bertoldi AD, Wehrmeister FC, Gonçalves H, Murray J, Rodrigues LT, Assumpção MC, Domingues MR, Hallal PRC. Prevalence, mortality and risk factors associated with very low birth weight preterm infants: an analysis of 33 years. JORNAL DE PEDIATRIA (VERSÃO EM PORTUGUÊS) 2020. [DOI: 10.1016/j.jpedp.2019.04.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
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122
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Victora JD, Silveira MF, Tonial CT, Victora CG, Barros FC, Horta BL, Santos ISD, Bassani DG, Garcia PCR, Scheeren M, Fiori HH. Prevalence, mortality and risk factors associated with very low birth weight preterm infants: an analysis of 33 years. J Pediatr (Rio J) 2020; 96:327-332. [PMID: 30550758 PMCID: PMC9432241 DOI: 10.1016/j.jped.2018.10.011] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2018] [Revised: 10/03/2018] [Accepted: 10/17/2018] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE To assess the prevalence, mortality and risk factors associated with the birth of very low birth weight preterm infants over a period of 33 years. METHODS Four cross-sectional studies were analyzed, using data from perinatal interviews of birth cohorts in the city of Pelotas collected in 1982, 1993, 2004, and 2015. Based on perinatal questionnaires, anthropometric measurements of newborns and death certificates were analyzed to obtain the prevalence rate, neonatal mortality, and risk factors (maternal age, income and type of delivery) for very low birth weight. RESULTS A total of 19,625 newborns were included in the study. In the years 1982, 1993, 2004, and 2015, there were, respectively, 5909, 5232, 4226, and 4258 births. The prevalence of very low birth weight was, respectively, 1.1% (n=64), 0.9% (n=46), 1.4% (n=61), and 1.3% (n=54). There was no statistical evidence of an increasing trend over time (p=0.11). Among the risk factors, family income in the three poorest quintiles was associated with prevalence rates that were approximately twice as high as in the richest quintile (p=0.003). Mortality per 1000 live births for neonates weighing <1500g decreased from 688 to 259 per thousand from 1982 to 2015 (p<0.001), but still represented 61% of neonatal deaths in the latter year. CONCLUSION Although mortality in very low birth weight decreased by more than 60% in recent years, this group still contributes with more than half of neonatal deaths. Low family income remains an important risk factor in this scenario.
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Affiliation(s)
- Julia Damiani Victora
- Pontifícia Universidade Católica do Rio Grande do Sul (PUCRS), Hospital São Lucas, Programa de Pós-Graduação em Pediatria e Saúde da Criança, Porto Alegre, RS, Brazil
| | | | - Cristian Tedesco Tonial
- Pontifícia Universidade Católica do Rio Grande do Sul (PUCRS), Hospital São Lucas, Programa de Pós-Graduação em Pediatria e Saúde da Criança, Porto Alegre, RS, Brazil.
| | - Cesar Gomes Victora
- Universidade Federal de Pelotas (UFPel), Programa de Pós-Graduação em Epidemiologia, Pelotas, RS, Brazil
| | - Fernando Celso Barros
- Universidade Federal de Pelotas (UFPel), Programa de Pós-Graduação em Epidemiologia, Pelotas, RS, Brazil
| | - Bernardo Lessa Horta
- Universidade Federal de Pelotas (UFPel), Programa de Pós-Graduação em Epidemiologia, Pelotas, RS, Brazil
| | - Iná Silva Dos Santos
- Universidade Federal de Pelotas (UFPel), Programa de Pós-Graduação em Epidemiologia, Pelotas, RS, Brazil
| | - Diego Garcia Bassani
- University of Toronto, Center for Global Child Health, The Hospital for Sick Children and Department of Pediatrics, Toronto, Canada
| | - Pedro Celiny R Garcia
- Pontifícia Universidade Católica do Rio Grande do Sul (PUCRS), Hospital São Lucas, Programa de Pós-Graduação em Pediatria e Saúde da Criança, Porto Alegre, RS, Brazil
| | - Marola Scheeren
- Pontifícia Universidade Católica do Rio Grande do Sul (PUCRS), Hospital São Lucas, Programa de Pós-Graduação em Pediatria e Saúde da Criança, Porto Alegre, RS, Brazil
| | - Humberto H Fiori
- Pontifícia Universidade Católica do Rio Grande do Sul (PUCRS), Hospital São Lucas, Programa de Pós-Graduação em Pediatria e Saúde da Criança, Porto Alegre, RS, Brazil
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Huang J, Lin J, Cai R, Lu X, Song N, Gao H, Zhu J, Kuang Y. Effect of a prior cesarean delivery on pregnancy outcomes of frozen-thawed embryo transfer: A retrospective cohort study in a freeze-all setting. Acta Obstet Gynecol Scand 2020; 99:1303-1310. [PMID: 32249931 DOI: 10.1111/aogs.13863] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2020] [Revised: 03/04/2020] [Accepted: 03/28/2020] [Indexed: 12/17/2022]
Abstract
INTRODUCTION The association between the mode of previous delivery and subsequent success of assisted reproductive treatment has been poorly understood. By mitigating the detrimental effect of supraphysiologic estradiol levels on endometrial receptivity, a freeze-all strategy provides a novel model to investigate the sole impact of a prior cesarean delivery (CD) on embryo transfer outcomes. MATERIAL AND METHODS This single-center retrospective cohort study included 2660 patients who underwent their first frozen-thawed embryo transfer cycles after a freeze-all policy from January 2013 to December 2018. Patients with a history of live birth by CD were assigned to the CD group, and those with only vaginal delivery (VD) were categorized into the VD group. The primary outcome measure was live birth. Baseline characteristics of the two groups were balanced by propensity score matching in a ratio of 1:1. Univariate and multivariate logistic regression analyses were performed using the after-matching data. RESULTS Compared with the VD group, the rates of clinical pregnancy (38.3% vs 44.5%; P = .005) and live birth (27.5% vs 33.4%; P = .003) were significantly lower in women with a history of CD. When adjusted for a number of major confounding factors, the negative association between a prior CD and frozen-thawed embryo transfer success was maintained, with the adjusted odds ratio (OR) being 0.80 (95% CI 0.66-0.96) and 0.78 (95% CI 0.63-0.95) for clinical pregnancy and live birth, respectively. Furthermore, a CD history conferred a marginally increased risk of early miscarriage (crude OR 1.48, 95% CI 1.04-2.11; adjusted OR 1.47, 95% CI 1.01-2.14), whereas the odds of multiple and ectopic pregnancy did not show significant differences before and after adjustment. CONCLUSIONS A prior CD was associated with a decreased chance of live birth and an increased risk of early miscarriage in frozen-thawed embryo transfer cycles.
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Affiliation(s)
- Jialyu Huang
- Department of Assisted Reproduction, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Jiaying Lin
- Department of Assisted Reproduction, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Renfei Cai
- Department of Assisted Reproduction, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Xuefeng Lu
- Department of Assisted Reproduction, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Ning Song
- Department of Histology, Embryology, Genetics and Developmental Biology, Shanghai Key Laboratory for Reproductive Medicine, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Hongyuan Gao
- Department of Assisted Reproduction, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Jing Zhu
- Department of Assisted Reproduction, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yanping Kuang
- Department of Assisted Reproduction, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
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Silva AAMD, Carvalho CAD, Bettiol H, Goldani MZ, Lamy Filho F, Lamy ZC, Domingues MR, Cardoso VC, Cavalli RDC, Horta BL, Barros AJD, Barbieri MA. Mean birth weight among term newborns: direction, magnitude and associated factors. CAD SAUDE PUBLICA 2020; 36:e00099419. [PMID: 32267386 DOI: 10.1590/0102-311x00099419] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2019] [Accepted: 09/06/2019] [Indexed: 11/22/2022] Open
Abstract
A trend towards increasing birth weight has been shown, but factors that explain these trends have not been elucidated. The objectives of this study were to evaluate changes in mean birth weight of term newborns and to identify factors associated with them. All cohorts are population-based studies in which random samples of births (Ribeirão Preto, São Paulo State in 1978/1979, 1994 and 2010; Pelotas, Rio Grande do Sul State in 1982, 1993 and 2004; and São Luís, Maranhão State in 1997/1998 and 2010, Brazil). A total of 32,147 full-term, singleton live births were included. Mean birth weight reduced in the first study period (-89.1g in Ribeirão Preto from 1978/1979 to 1994, and -27.7g in Pelotas from 1982 to 1993) and increased +30.2g in Ribeirão Preto from 1994 to 2010 and +24.7g in São Luís from 1997 to 2010. In the first period, in Ribeirão Preto, mean birth weight reduction was steeper among mothers with high school education and among those born 39-41 weeks. In the second period, the increase in mean birth weight was steeper among mothers with low schooling in Ribeirão Preto and São Luís, females and those born 37-38 weeks in Ribeirão Preto and cesarean section in São Luís. Birth weight decreased in the first study period then increased thereafter. The variables that seem to have been able to explain these changes varied over time.
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Carvalho CA, Silva AAMD, Victora C, Goldani M, Bettiol H, Thomaz EBAF, Barros F, Horta BL, Menezes A, Cardoso V, Cavalli RC, Santos I, Batista RFL, Simões VM, Barbieri M, Barros A. Changes in Infant and Neonatal Mortality and Associated Factors in Eight Cohorts from Three Brazilian Cities. Sci Rep 2020; 10:3249. [PMID: 32094364 PMCID: PMC7039903 DOI: 10.1038/s41598-020-59910-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2019] [Accepted: 01/31/2020] [Indexed: 01/06/2023] Open
Abstract
Stillbirth (SBR), perinatal (PMR), neonatal (NMR) and infant mortality rates (IMR) are declining in Brazil and the factors associated with these falls are still being investigated. The objective of the present study was to assess changes in SBR, PMR, NMR and IMR over time and to determine the factors associated with changes in NMR and IMR in eight Brazilian cohorts. All cohorts are population-based (Ribeirão Preto in 1978/79, 1994 and 2010; Pelotas in 1982, 1993 and 2004; and São Luís in 1997/98 and 2010). Were included data on 41440 children. All indicators were decreased, except in the city of Pelotas, from 1993 to 2004, and except SBR in São Luís. Sociodemographic variables seem to be able to explain reductions of NMR and IMR in Ribeirão Preto, from 1978/79 to 1994, and in São Luís. In Ribeirão Preto, from 1994 to 2010 declines in NMR and IMR seem to be explained by reductions in intrauterine growth restriction (IUGR). Newborn’s gestational age had diminished in all cohorts, preventing even greater reductions of NMR and IMR. Improved sociodemographic variables and reduction of IUGR, seem to be able to explain part of the decrease observed. NMR and IMR could have been reduced even more, were it not for the worsening in gestational age distribution.
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Affiliation(s)
- Carolina A Carvalho
- Federal Institute of Maranhão; Federal University of Maranhão, Post Graduate Program in Collective Health, Rua Barão de Itapary, nº 155, Centro, Zipcode: 65.020-070, São Luís, MA, Brazil.
| | - Antônio A M da Silva
- Federal University of Maranhão, Post Graduate Program in Collective Health, Rua Barão de Itapary, nº 155, Centro, Zipcode: 65.020-070, São Luís, MA, Brazil
| | - César Victora
- Federal University of Pelotas, Post Graduate Program in Epidemiology, Pelotas, Brazil
| | - Marcelo Goldani
- Federal University of Rio Grande do Sul, Department of Pediatrics, Porto Alegre, Brazil
| | - Heloísa Bettiol
- University of São Paulo, Department of Puericulture and Pediatrics, Ribeirão Preto, Brazil
| | - Erika Barbara Abreu Fonseca Thomaz
- Federal University of Maranhão, Post Graduate Program in Collective Health, Rua Barão de Itapary, nº 155, Centro, Zipcode: 65.020-070, São Luís, MA, Brazil
| | - Fernando Barros
- Catholic University of Pelotas, Post-Graduate Program in Health and Behavior and Federal University of Pelotas, Post Graduate Program in Epidemiology, Pelotas, Brazil
| | - Bernardo L Horta
- Federal University of Pelotas, Post Graduate Program in Epidemiology, Pelotas, Brazil.,University of São Paulo, Department of Puericulture and Pediatrics, Ribeirão Preto, Brazil
| | - Ana Menezes
- Federal University of Pelotas, Post Graduate Program in Epidemiology, Pelotas, Brazil
| | - Viviane Cardoso
- University of São Paulo, Department of Puericulture and Pediatrics, Ribeirão Preto, Brazil
| | | | - Iná Santos
- Federal University of Pelotas, Post Graduate Program in Epidemiology, Pelotas, Brazil.,Catholic University of Pelotas, Post-Graduate Program in Health and Behavior and Federal University of Pelotas, Post Graduate Program in Epidemiology, Pelotas, Brazil
| | - Rosângela F L Batista
- Federal University of Maranhão, Post Graduate Program in Collective Health, Rua Barão de Itapary, nº 155, Centro, Zipcode: 65.020-070, São Luís, MA, Brazil
| | - Vanda Maria Simões
- Federal University of Maranhão, Post Graduate Program in Collective Health, Rua Barão de Itapary, nº 155, Centro, Zipcode: 65.020-070, São Luís, MA, Brazil
| | - Marco Barbieri
- University of São Paulo, Department of Puericulture and Pediatrics, Ribeirão Preto, Brazil
| | - Aluisio Barros
- Federal University of Pelotas, Post Graduate Program in Epidemiology, Pelotas, Brazil
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Cesar JA, Camerini AV, Paulitsch RG, Terlan RJ. Non-performance of serological tests for syphilis during prenatal care: prevalence and associated factors. REVISTA BRASILEIRA DE EPIDEMIOLOGIA 2020; 23:e200012. [PMID: 32130400 DOI: 10.1590/1980-549720200012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2018] [Accepted: 11/13/2018] [Indexed: 03/07/2023] Open
Abstract
INTRODUCTION Syphilis is a sexually transmitted disease, easy to diagnose and treat, but whose incidence is increasing in Brazil. This study estimated the prevalence of the non-performance of serological tests for syphilis during prenatal care, in addition to evaluating its trend and identifying its associated factors in the municipality of Rio Grande, Rio Grande do Sul, Southern Brazil. METHODS This is a cross-sectional survey that included all pregnant women living in this municipality who gave birth between January 1 and December 31, 2007, 2010, and 2013. A single standardized questionnaire was administered to the mothers within 48 hours of delivery, while they were still in the maternity ward. We used the χ2 test for proportions and linear trend, and Poisson regression with robust adjustment in the multivariate analysis. The effect measure adopted was prevalence ratio (PR). RESULTS Among the 7,351 mothers who had at least one prenatal visit, the prevalence of non-performance of serological tests for syphilis in the three years studied was 2.9% (95% confidence interval - 95%CI 2.56 - 3.33), with 3.3% (95%CI 2.56 - 3.97) in 2007, 2.8% (95%CI 2.20 - 3.52) in 2010, and 2.7% (95%CI 2.12 - 3.38) in 2013. Black mothers, those with low household income and schooling, and who had few prenatal visits showed higher PR of non-performance of this test. DISCUSSION The prevalence of non-performance has virtually not changed in the period, and women with high-risk pregnancy showed a greater probability of not undergoing the test. CONCLUSIONS This municipality needs to reach mothers with lower socioeconomic status, restructure the local health services, and enhance their operationalization to improve the quality of prenatal care.
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Affiliation(s)
- Juraci Almeida Cesar
- Programa de Pós-graduação em Saúde Pública, Faculdade de Medicina, Universidade Federal do Rio Grande - Rio Grande (RS), Brasil
| | - Adriana Vieira Camerini
- Programa de Pós-graduação em Saúde Pública, Faculdade de Medicina, Universidade Federal do Rio Grande - Rio Grande (RS), Brasil
| | - Renata Gomes Paulitsch
- Programa de Pós-graduação em Saúde Pública, Faculdade de Medicina, Universidade Federal do Rio Grande - Rio Grande (RS), Brasil
| | - Rodrigo Jacobi Terlan
- Programa de Pós-graduação em Saúde Pública, Faculdade de Medicina, Universidade Federal do Rio Grande - Rio Grande (RS), Brasil
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127
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Reinheimer SM, Schmidt MI, Duncan BB, Drehmer M. Factors Associated With Breastfeeding Among Women With Gestational Diabetes. J Hum Lact 2020; 36:126-135. [PMID: 31071277 DOI: 10.1177/0890334419845871] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Breastfeeding offers benefits to mother and child but is frequently not practiced among women whose pregnancy is complicated by gestational diabetes mellitus. Factors associated with not initiating or not maintaining breastfeeding among these women have been little investigated. RESEARCH AIMS (1) To evaluate the frequency of breastfeeding for 30 days among women with a recent pregnancy complicated by gestational diabetes and (2) to determine factors associated with not initiating or not maintaining breastfeeding. METHODS Between January 2014 and July 2017 we enrolled women with gestational diabetes at high-risk prenatal services in three Brazilian cities. We collected baseline sociodemographic and health data and followed up with participants by telephone. Using Kaplan-Meier curves, we calculated the proportions of participants not initiating breastfeeding or not maintaining it for at least 30 days. We used Poisson regression with robust variance to identify factors related to this outcome. RESULTS Of the 2328 participants with complete information, 2236 (96.1%) initiated breastfeeding, and 2166 (93.1%) maintained breastfeeding for 30 days. Not having breastfed the previous infant (relative risk [RR] = 5.02, 95% CI [3.39, 7.45]), smoking during pregnancy (RR = 2.37, 95% CI [1.48, 3.80]), infant with health problems (RR = 2.25, 95% CI [1.27, 3.99]), early preterm birth (RR = 2.49, 95% CI [1.07, 5.77]), and not intending to breastfeed (RR = 3.73, 95% CI [1.89, 7.33]) were related to not maintaining breastfeeding for at least 30 days. CONCLUSIONS Breastfeeding initiation was nearly universal among participants, and most maintained breastfeeding for 30 days. Factors relating to not breastfeeding at 30 days were easily identifiable.
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Affiliation(s)
- Shaline Modena Reinheimer
- Postgraduate Studies Program in Epidemiology, Department of Social Medicine, School of Medicine, Federal University of Rio Grande do Sul, Porto Alegre, Brazil
| | - Maria Inês Schmidt
- Postgraduate Studies Program in Epidemiology, Department of Social Medicine, School of Medicine, Federal University of Rio Grande do Sul, Porto Alegre, Brazil
| | - Bruce Bartholow Duncan
- Postgraduate Studies Program in Epidemiology, Department of Social Medicine, School of Medicine, Federal University of Rio Grande do Sul, Porto Alegre, Brazil
| | - Michele Drehmer
- Postgraduate Studies Program in Epidemiology, Department of Social Medicine, School of Medicine, Federal University of Rio Grande do Sul, Porto Alegre, Brazil.,Postgraduate Studies Program in Food, Nutrition and Health, Department of Nutrition, School of Medicine, Federal University of Rio Grande do Sul, Porto Alegre, Brazil
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128
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Flores TR, Neves RG, Mielke GI, Bertoldi AD, Nunes BP. [Inequalities on coverage of prenatal assistance in Brazil: a nationwide study]. CIENCIA & SAUDE COLETIVA 2020; 26:593-600. [PMID: 33605336 DOI: 10.1590/1413-81232021262.26792019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2019] [Accepted: 01/20/2020] [Indexed: 11/22/2022] Open
Abstract
This article aims to evaluate the coverage and inequalities in prenatal assistance. Data from the Brazilian National Health Survey cross-sectional study in 2013. Prenatal assistance assessed through indicators: counseling, guidance received, procedures, and exams performed during the pregnancy. An asset index constructed, the Slope Index of Inequality (SII) and Concentration Index (CIX) were used to measure. About 90% received counseling on healthy eating, not smoking and drinking, 80% not to use dye/hair straightening, and all the advice. Approximately 70% received guidance on delivery and signs of risk and 83.4% for breastfeeding and 60% all the guidelines. About 80% had the measure of pressure and weight checked, the measure of the abdomen and the auscultation of the heart of the baby, only 36.7% had their breasts examined e 33.4% all procedures performed. More than 90% held for HIV and urine and 77.9% for syphilis, 81.4% of women have carried out all the exams and 21.7% all the indicators. No significant absolute differences (SII) found. CIX evidenced in counseling for healthy eating and guidance for breastfeeding. There were no marked inequalities in prenatal assistance.
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Affiliation(s)
- Thaynã Ramos Flores
- Programa de Pós-Graduação em Epidemiologia, Universidade Federal de Pelotas (UFPel). R. Marechal Deodoro 1160, Bairro Centro. 96020-220 Pelotas RS Brasil.
| | | | - Grégore Iven Mielke
- Programa de Pós-Graduação em Epidemiologia, Universidade Federal de Pelotas (UFPel). R. Marechal Deodoro 1160, Bairro Centro. 96020-220 Pelotas RS Brasil.
| | - Andréa Dâmaso Bertoldi
- Programa de Pós-Graduação em Epidemiologia, Universidade Federal de Pelotas (UFPel). R. Marechal Deodoro 1160, Bairro Centro. 96020-220 Pelotas RS Brasil.
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Santos RV, Borges GM, Campos MBD, Queiroz BL, Coimbra CEA, Welch JR. Indigenous children and adolescent mortality inequity in Brazil: What can we learn from the 2010 National Demographic Census? SSM Popul Health 2020; 10:100537. [PMID: 31989016 PMCID: PMC6970167 DOI: 10.1016/j.ssmph.2020.100537] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2019] [Revised: 01/06/2020] [Accepted: 01/07/2020] [Indexed: 11/24/2022] Open
Abstract
Indigenous peoples worldwide are highly disadvantaged compared to national baseline populations. Given historical challenges to accessing relevant data for Brazil, the present study innovates by using 2010 Brazilian National Demographic Census data to estimate mortality curves in Indigenous children and adolescents <20 years. The non-parametric smoothing approach TOPALS (tool for projecting age-specific rates using linear splines) was employed. Analyses included stratifications by sex, rural or urban residence, and geopolitical region. The mortality of children and adolescents classified as Indigenous was higher for all analyzed strata. Mortality of Indigenous and non-Indigenous individuals in rural areas was higher than those in urban areas in almost all strata analyzed. Mortality levels in the Indigenous segment exceed those of children and adolescents classified as non-Indigenous in all four geopolitical regions, with few exceptions. This is the first study to compare mortality curves of children and adolescents in Brazil according to social variables based on national census data. More Indigenous children and adolescents die than their non-Indigenous counterparts, including those classified as black or brown, in both rural and urban residential settings. Indigenous children and adolescents are consistently at the most disadvantaged end of a marked gradient of ethnic-racial inequality in Brazil, independently of sex, age, and geopolitical region.
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Affiliation(s)
- Ricardo Ventura Santos
- Escola Nacional de Saúde Pública, Fundação Oswaldo Cruz, Rua Leopoldo Bulhões 1480, Rio de Janeiro, RJ, 21041-210, Brazil.,Departamento de Antropologia, Museu Nacional, Universidade Federal do Rio de Janeiro, Quinta da Boa Vista s/n, Rio de Janeiro, RJ, 20940-040, Brazil
| | - Gabriel Mendes Borges
- Instituto Brasileiro de Geografia e Estatística, Av. Presidente Antonio Carlos 25, Rio de Janeiro, RJ, 20020-010, Brazil
| | - Marden Barbosa de Campos
- Departamento de Sociologia, Faculdade de Filosofia e Ciências Humanas, Universidade Federal de Minas Gerais, Av. Antônio Carlos 6627, Belo Horizonte, MG, 31270-901, Brazil
| | - Bernardo Lanza Queiroz
- Centro de Desenvolvimento e Planejamento Regional, Faculdade de Ciências Econômicas, Universidade Federal de Minas Gerais, Avenida Antônio Carlos 6627, Belo Horizonte, MG, 31270-901, Brazil
| | - Carlos E A Coimbra
- Escola Nacional de Saúde Pública, Fundação Oswaldo Cruz, Rua Leopoldo Bulhões 1480, Rio de Janeiro, RJ, 21041-210, Brazil
| | - James R Welch
- Escola Nacional de Saúde Pública, Fundação Oswaldo Cruz, Rua Leopoldo Bulhões 1480, Rio de Janeiro, RJ, 21041-210, Brazil
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Souza JPDO, Ferreira CS, Lamounier DMB, Pereira LA, Rinaldi AEM. CHARCTERIZATION OF FEEDING OF CHILDREN UNDER 24 MONTHS IN UNITS CARED BY THE FAMILY HEALTH STRATEGY. REVISTA PAULISTA DE PEDIATRIA 2020; 38:e2019027. [PMID: 32187301 PMCID: PMC7077794 DOI: 10.1590/1984-0462/2020/38/2019027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/30/2019] [Accepted: 06/21/2019] [Indexed: 12/03/2022]
Abstract
Objective: To describe the median age of introduction and regular food intake by young
children in units of the Family Health Strategy. Methods: Cross-sectional study with 283 young children chosen by uniform stratified
cluster sampling. Socio-demographic data on the mother and the child’s food
intake were collected (age of food introduction and weekly frequency). Foods
were grouped into in natura/minimally processed (G1);
culinary ingredients (G2); processed (G3) and ultra-processed (G4). The
survival analysis was applied to define the median age of food introduction
and the chi-square test was used to compare the frequency of food intake,
according to the age range (0-5.9; 6-11.9; and 12-23.9 months old). Results: The median duration of exclusive breastfeeding and breastfeeding were three
and 19 months, respectively. The age of median food introduction of G1 was
six months, except for eggs, milk and coffee (12 months). For oil and salt
(G2), the median was 6 months, and for sugar (G2), seven months. The median
age of introduction of most food of G4 was 12 months; for infant formulas,
it was seven months; cookies and baby food, eight months. Most food had not
yet been introduced for children under six months old. For children from six
to 11.9 months old, the regular consumption of G4 (≥5 days/week) was higher
for cookies (23.8%), bread (21.2%), infant formulas (21.2%) and baby food
(35%); and for children from 12 to 23.9 months old, it was higher for
cookies (31.2%), bread (57.5%) and baby food (48.7%). Conclusions: Food introduced and consumed on a regular basis was mainly in
natura, at all ages. Processed and ultra-processed food
presented a higher frequency of consumption after 12 months old.
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131
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Demenech LM, Dumith SDC, Vieira MECD, Neiva-Silva L. Desigualdade econômica e risco de infecção e morte por COVID-19 no Brasil. REVISTA BRASILEIRA DE EPIDEMIOLOGIA 2020; 23:e200095. [DOI: 10.1590/1980-549720200095] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2020] [Accepted: 08/17/2020] [Indexed: 12/23/2022] Open
Abstract
RESUMO: Objetivo: Avaliar, por meio de análise espaçotemporal, se a desigualdade econômica das Unidades Federativas (UF) do Brasil pode estar associada com o risco de infecção e morte por COVID-19. Métodos: Trata-se de um estudo ecológico, baseado em dados secundários das taxas de incidência e mortalidade para COVID-19. Os dados foram analisados em nível estadual, tendo como principal variável independente o coeficiente de Gini. Foram utilizados os registros de 12 dias, espaçados em uma semana cada, entre 21 de abril e 7 de julho de 2020. A variação semanal das taxas foi calculada pela regressão de Prais-Winsten, com o objetivo de medir a evolução da pandemia em cada UF. O teste de correlação de Spearman foi empregado para avaliar a correlação entre as taxas e suas evoluções semanais e as variáveis independentes. Por fim, realizou-se diagnóstico de dependência espacial dos dados e usou-se o modelo de defasagem da regressão espacial, quando aplicável. Resultados: As taxas de incidência e mortalidade por COVID-19 foram crescentes em todas as UF brasileiras, tendo sido mais acentuada entre aquelas com maior desigualdade econômica. A associação entre coeficiente de Gini e incidência e mortalidade por COVID-19 manteve-se mesmo quando levados em consideração aspectos demográficos e espaciais. Conclusão: A desigualdade econômica pode exercer papel importante no impacto da COVID-19 em território brasileiro, por meio de efeitos absolutos e contextuais. Políticas estruturais para a redução da desigualdade são fundamentais para o enfrentamento dessa e de futuras crises sanitárias no Brasil.
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132
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Carcavalli L, Rocha IA, Valentim AF, Penido MG, Parlato EM, Pordeus IA, Serra-Negra JM. Difference of Socioeconomic Factors among Mothers of Preterm and Full-Term Infant. PESQUISA BRASILEIRA EM ODONTOPEDIATRIA E CLÍNICA INTEGRADA 2020. [DOI: 10.1590/pboci.2020.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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133
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Abstract
Resumo Este estudo propõe uma revisão crítica da legislação voltada para a assistência obstétrica, nomeadamente no que concerne ao processo da parturição. A história recente mostra numerosas iniciativas governamentais através de legislação e de políticas públicas que garantem direitos às mulheres. Buscou-se identificar possíveis convergências e descompassos nas relações entre a legislação e as políticas, especialmente no que tange ao asseguramento de direitos. Procedeu-se à análise documental do material selecionado seguindo os parâmetros recomendados na literatura. A presença do acompanhante foi o tema focalizado na análise. O período histórico coberto pelo estudo teve como marcador temporal a promulgação da Lei nº 11.108/2005. Os resultados apresentados revelaram um conjunto considerável de diplomas sancionados e incorporados pelos órgãos governamentais da administração federal. Todavia, o crescente fortalecimento dos direitos focalizados não se fez repercutir no cotidiano dos serviços que deveriam implementá-los. Apesar dos avanços, o problema da proteção e usufruto dos direitos ainda persiste. É possível cogitar que o fortalecimento político do campo contra-hegemônico representa perspectiva promissora para a superação das dificuldades ao legítimo exercício da cidadania.
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Jaramillo MC, Chernichovsky D, Jiménez Moleón JJ. An assessment of infant mortality rates in Colombia, 1980-2009. Colomb Med (Cali) 2019; 50:275-285. [PMID: 32476693 PMCID: PMC7232950 DOI: 10.25100/cm.v50i4.2205] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
PURPOSE The infant mortality rate is a key indicator of human welfare and development. However, in Colombia, the Departamento Administrativo Nacional de Estadística has set the registered rate for 2009 as 13.69 per 1,000 live births, while the estimated rate is 20.13, suggesting the presence of inconsistencies in the data, as in many other transitional economies. Objective: To set the record straight on Colombia's Infant mortality rate reporting since 1980 by using all available data that have recently become public. METHODS . The study analyzes 8,636,510 records of live births (1998-2009) and 443,338 records of deaths (1979-2009), and considers information from all available sources: births and death registries, census data, Departamento Administrativo Nacional de Estadística, and Profamilia surveys. First, following a descriptive analysis, an exponential function is used to estimate the Infant mortality rates in Colombia for 1980-2009 while resolving internal inconsistencies in the data from all sources. The objective is to evaluate the infant mortality rate in Colombia, 1980-2009. RESULTS The analysis demonstrates that the registered and the estimated rates for 2009 are incompatible since they follow inconsistent long-term rates of decline in Infant mortality rate. While the registered rate underestimates the real situation, the estimated rate appears to grossly overestimate it. Analyses, based on other sources, put the Infant mortality rate between 15.81 and 17.58 in 2009, with rates of decline between 3.0 and 5.0 percent for the period 1980-2009. CONCLUSIONS The study concludes that during the period 1980-2009, the Infant mortality rate for Colombia on average fell from about 54 to about 17, suggesting a long-term annual rate of decline of about 4.0 percent.
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Affiliation(s)
- Marta Cecilia Jaramillo
- Universidad Icesi, Facultad de Ciencias Administrativas y Económicas, Departamento de Gestión Organizacional, Cali, Colombia
| | - Dov Chernichovsky
- University of Ben-Gurion de Negev, Health Systems Management Department, Faculty Member. Israel
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Oliveira CVRD, Palombo CNT, Toriyama ÁTM, Veríssimo MDLÓR, Castro MCD, Fujimori E. Health inequalities: child development in different social groups. Rev Esc Enferm USP 2019; 53:e03499. [PMID: 31800802 DOI: 10.1590/s1980-220x2018037103499] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2018] [Accepted: 01/22/2019] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE To analyze child development in different social groups. METHOD A cross-sectional study with children under 3 years old enrolled in basic health units of a municipality in the state of São Paulo, Brazil. Child development was verified by the Ministry of Health's Development Monitoring Form. The Social Class Index was used to classify families into social groups and the predefined hierarchical theoretical model for univariate and multiple logistic regression analysis. RESULTS The sample consisted of 348 children, in which 29% of the children presented the absence of some developmental milestone expected for their age, while social group and age group were associated with child development in the final model. Children from the least socially inserted groups aged 12 months or older were more likely to be missing some developmental milestone. CONCLUSION The proportion of children with the absence of some developmental milestones is high and associated with lower social inclusion. The importance of developmental surveillance by the primary care nursing team is emphasized in order to identify the most vulnerable groups and to implement early interventions which can minimize the negative effects which worsen with age.
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Affiliation(s)
| | | | - Áurea Tamami Minagawa Toriyama
- Universidade de São Paulo, Escola de Enfermagem, Departamento de Enfermagem Materno-infantil e Psiquiátrica, São Paulo, SP, Brasil
| | - Maria de La Ó Ramallo Veríssimo
- Universidade de São Paulo, Escola de Enfermagem, Departamento de Enfermagem Materno-infantil e Psiquiátrica, São Paulo, SP, Brasil
| | - Márcia Caldas de Castro
- Harvard University School of Public Health, Department Global Health and Population, Boston, MA, United States
| | - Elizabeth Fujimori
- Universidade de São Paulo, Escola de Enfermagem, Departamento de Enfermagem em Saúde Coletiva, São Paulo, SP, Brasil
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Silva TPRD, Dumont-Pena É, Sousa AMM, Amorim T, Tavares LC, Nascimento DCDP, Souza KVD, Matozinhos FP. Obstetric Nursing in best practices of labor and delivery care. Rev Bras Enferm 2019; 72:235-242. [DOI: 10.1590/0034-7167-2018-0561] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2018] [Accepted: 11/08/2018] [Indexed: 11/22/2022] Open
Abstract
ABSTRACT Objective: to evaluate the association of Obstetric Nursing in the best practices of delivery and birth care in maternity hospitals. Method: a cross-sectional study, with 666 women selected for delivery. Parturition obstetric practices performed by professionals were categorized into: clearly useful practices that should be encouraged, practices that are clearly harmful or ineffective and that should be eliminated and practices used inappropriately at the time of parturition. Results: clearly useful practices were used in greater proportions in the hospitals that had Obstetric Nursing working, while clearly harmful practices and those used inappropriately were practiced in smaller proportions in hospitals that had Obstetric Nursing, both with statistical difference. Conclusion: institutions with Obstetric Nursing adopt better practices of delivery and birth care, based on scientific evidence, when compared to those that do not act.
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137
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Abstract
Drawing on a historical ethnography conducted in Southern Brazil, this article explores how public health programs for adolescent reproductive and mental health have emerged in Brazil and begun to intersect with the growing field of "global mental health" (GMH). The story I recount begins not in the 2010s with the rapid rise of expert interest in adolescent health within GMH, but in the 1990s, the decade when young teens in Brazil were first coming into contact with practices and approaches in research, schools and clinics that have both underpinned and critiqued the production of an adolescent mental and reproductive health sub-field. In parsing what young women's encounters with the then newly-emerging questionnaires, measurement tools, school-based programs and clinical practices came to mean to them, I use a genealogical approach to consider how histories of education reform, population control, psychoanalysis, social medicine, the transition to democracy, feminism and grass-roots politics all entered the fold, shaping the way adolescent sex-and-psyche materialized as a contested object of expertise. I end by exploring what this case can teach global mental health advocates and social theorists about practices of critique.
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Affiliation(s)
- Dominique P Béhague
- Center for Medicine, Health and Society, Vanderbilt University, Nashville, USA.
- Department of Global Health & Social Medicine, King's College London, London, UK.
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138
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Salgado HDO, Queiroz MR, Dos Santos HG, Andreucci CB, Diniz CSG. Using the Maternity Safety Thermometer to estimate harm-free care in Southeast Brazil: A hospital-based cohort. Birth 2019; 46:583-591. [PMID: 31579979 DOI: 10.1111/birt.12454] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2019] [Revised: 08/23/2019] [Accepted: 08/23/2019] [Indexed: 11/30/2022]
Abstract
BACKGROUND High rates of unnecessary cesareans and interventions in vaginal births contribute to stagnant maternal and neonatal mortality rates in Brazil. We used the Maternity Safety Thermometer (MST) to assess the prevalence of harm during maternity care. METHODS This secondary analysis of the "Birth in Brazil" survey included a representative sample of 10 155 women who gave birth in public and private hospitals in southeastern Brazil. The main outcomes were perineal and abdominal trauma, maternal infection and hemorrhage, newborn vitality, and women's perception of safety. We calculated the odds ratios (OR) for the number of MST harms (dependent variable). RESULTS About 81.6% of the women with vaginal births had sutures for perineal trauma (87.7% of these due to episiotomies). Poor perception of safety was reported by 83.1% of women, and 69.5% of all infants not admitted to the NICU were separated from their mother after birth. The overall rate of cesarean birth was 52.6%, and 7.5% of term infants were admitted to the NICU. In public settings, having an intrapartum cesarean significantly increased the chances of one (OR 2.21; 95% CI 1.20-4.07), or two or more (4.08 [2.27-7.32]) harms. In private settings, cesarean deliveries without labor were also associated with higher chances of one (4.26 [2.65-6.85]), or two or more (4.60 [2.35-9.02]) harms. Only 2% of the women had harm-free care. CONCLUSIONS In southeastern Brazil, there is a high prevalence of preventable harm during maternity care.
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Affiliation(s)
| | | | | | - Carla Betina Andreucci
- Department of Medicine - Center for Biological and Health Sciences, Federal University of Sao Carlos, São Paulo, Brazil
| | - Carmen Simone Grilo Diniz
- Department of Health, Life Cycles and Society, School of Public Health, University of São Paulo, São Paulo, Brazil
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139
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Figueiredo MGOP, Takita SY, Dourado BMR, Mendes HDS, Terakado EO, Nunes HRDC, da Fonseca CRB. Periodontal disease: Repercussions in pregnant woman and newborn health-A cohort study. PLoS One 2019; 14:e0225036. [PMID: 31756178 PMCID: PMC6874354 DOI: 10.1371/journal.pone.0225036] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2019] [Accepted: 10/28/2019] [Indexed: 01/13/2023] Open
Abstract
The periodontal disease during pregnancy triggers an exacerbated immune response with high local and systemic concentrations of inflammatory markers.
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Affiliation(s)
| | - Stefanie Yaemi Takita
- Pediatrics Department, Botucatu Medical School, São Paulo State University (UNESP),Botucatu city, São Paulo State, Brazil
| | - Bianca Maria Ramos Dourado
- Pediatrics Department, Botucatu Medical School, São Paulo State University (UNESP),Botucatu city, São Paulo State, Brazil
| | | | - Erick Olsen Terakado
- Psychology Department, Paulista University (UNIP), São Paulo city, São Paulo State, Brazil
| | - Hélio Rubens de Carvalho Nunes
- Pediatrics Department, Botucatu Medical School, São Paulo State University (UNESP),Botucatu city, São Paulo State, Brazil
| | - Cátia Regina Branco da Fonseca
- Pediatrics Department, Botucatu Medical School, São Paulo State University (UNESP),Botucatu city, São Paulo State, Brazil
- * E-mail: ,
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Koch DM, Rattmann YD. Use of misoprostol in the treatment of postpartum hemorrhage: a pharmacoepidemiological approach. EINSTEIN-SAO PAULO 2019; 18:eAO5029. [PMID: 31721897 PMCID: PMC6896658 DOI: 10.31744/einstein_journal/2020ao5029] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2019] [Accepted: 06/27/2019] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVE To characterize the use of the drug misoprostol for treatment of postpartum hemorrhage in pregnant women. METHODS A descriptive observational study was carried out with secondary data from pregnant women who used misoprostol to treat postpartum hemorrhage in a reference public maternity, from July 2015 to June 2017. Clinical and sociodemographic profiles of pregnant women, how misoprostol was used and success rate in controling postpartum hemorrhage were characterized. RESULTS A total of 717 prescriptions of misoprostol were identified. Of these, 10% were for treatment of postpartum hemorrhage. The majority of pregnant women were young adults, married, with complete high school education, white, residing in urban areas, multiparous (68.1%) and 25% had previous cesarean sections. The mean gestational age was 39 weeks and 51.4% had a cesarean section. There was prophylactic use of oxytocin in 47.2% of women. Treatment of postpartum hemorrhage was successful in 84.7% of women. Of these, 79.2% also used oxytocin and 54.2% methylergonovine. Only 13.5% of pregnant women had less than five prenatal visits, and the main cause of postpartum hemorrhage was uterine atony. There were 13 complications after hemorrhage, 15.3% required blood transfusion and there was one case of maternal death. CONCLUSION Misoprostol showed to be effective and safe for treating postpartum hemorrhage.
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141
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Changes in maternity leave coverage: Implications for fertility, labour force participation and child mortality. Soc Sci Med 2019; 241:112573. [DOI: 10.1016/j.socscimed.2019.112573] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2018] [Revised: 08/29/2019] [Accepted: 09/24/2019] [Indexed: 11/21/2022]
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142
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Franzon ACA, Oliveira-Ciabati L, Bonifácio LP, Vieira EM, Andrade MS, Sanchez JAC, Braga GC, Nogueira-Pileggi V, Fernandes M, Souza JP. A communication and information strategy in health and preparation for childbirth: a randomized cluster trial (PRENACEL). CAD SAUDE PUBLICA 2019; 35:e00111218. [PMID: 31618382 DOI: 10.1590/0102-311x00111218] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2018] [Accepted: 03/29/2019] [Indexed: 11/22/2022] Open
Abstract
PRENACEL is a study that incorporates two innovative approaches to maternal and perinatal health: the need to improve women's level of satisfaction with the birthing experience and an assessment of the impacts of information and communication technologies in health. The approaches involve a communication program via short cellphone text messages, developed for Brazilian pregnant women in prenatal care in the Brazilian Unified National Health System. The analysis aims to determine whether the program contributes positively to women's perceived preparedness for childbirth. A randomized cluster trial was performed in 20 primary care units in Ribeirão Preto, São Paulo State, in 2015 and 2016. Data were collected for 1,210 women from interviews and patient charts. The data were submitted to two analytical models, per protocol and intention-to-treat. Women that had received information from the PRENACEL program during pregnancy were more likely to feel prepared for labor and delivery and to feel that prenatal care had helped them feel more prepared. There were also positive impacts on bonding with the newborn and breastfeeding in the delivery room and on knowledge of obstetric interventions. No differences were seen in the other maternal and perinatal outcomes, including women's satisfaction with the birthing care. PRENACEL can help expand women's access to strategic information for them to feel better prepared for the birthing experience.
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Affiliation(s)
| | | | | | | | - Magna Santos Andrade
- Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, São Paulo, Brasil
| | | | - Giordana Campos Braga
- Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, São Paulo, Brasil
| | | | - Mariana Fernandes
- Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, São Paulo, Brasil
| | - João Paulo Souza
- Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, São Paulo, Brasil
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143
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Gotardo JW, Volkmer NDFV, Stangler GP, Dornelles AD, Bohrer BBDA, Carvalho CG. Impact of peri-intraventricular haemorrhage and periventricular leukomalacia in the neurodevelopment of preterms: A systematic review and meta-analysis. PLoS One 2019; 14:e0223427. [PMID: 31600248 PMCID: PMC6786801 DOI: 10.1371/journal.pone.0223427] [Citation(s) in RCA: 48] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2019] [Accepted: 09/20/2019] [Indexed: 11/29/2022] Open
Abstract
CONTEXT Whether all degrees of periventricular leukomalacia (PVL) and peri-intraventricular haemorrhage (PIVH) have a negative impact on neurodevelopment. OBJECTIVE To determine the impact of PVL and PIVH in the incidence of cerebral palsy, sensorineural impairment and development scores in preterm neonates. Registered in PROSPERO (CRD42017073113). DATA SOURCES PubMed, Embase, SciELO, LILACS, and Cochrane databases. STUDY SELECTION Prospective cohort studies evaluating neurodevelopment in children born preterm which performed brain imaging in the neonatal period. DATA EXTRACTION Two independent researchers extracted data using a predesigned data extraction sheet. STATISTICAL METHODS A random-effects model was used, with Mantel-Haenszel approach and a Sidik-Jonkman method for the estimation of variances, combined with Hartung-Knapp-Sidik-Jonkman correction. Heterogeneity was assessed through the I2 statistic and sensitivity analysis were performed when possible. No funnel plots were generated but publication bias was discussed as a possible limitation. RESULTS Our analysis concluded premature children with any degree of PIVH are at increased risk for cerebral palsy (CP) when compared to children with no PIVH (3.4, 95% CI 1.60-7.22; 9 studies), a finding that persisted on subgroup analysis for studies with mean birth weight of less than 1000 grams. Similarly, PVL was associated with CP, both in its cystic (19.12, 95% CI 4.57-79.90; 2 studies) and non-cystic form (9.27, 95% CI 5.93-14.50; 2 studies). We also found children with cystic PVL may be at risk for visual and hearing impairment compared to normal children, but evidence is weak. LIMITATIONS Major limitations were the lack of data for PVL in general, especially for the outcome of neurodevelopment, the high heterogeneity among methods used to assess neurodevelopment and the small number of studies, which led to meta-analysis with high heterogeneity and wide confidence intervals. CONCLUSIONS There was no evidence supporting the hypothesis that PIVH causes impairment in neuropsychomotor development in our meta-analysis, but review of newer studies show an increased risk for lower intelligence scores in children with severe lesions, both PIVH and PVL. There is evidence to support the hypothesis that children with any degree of PIVH, especially those born below 1000 grams and those with severe haemorrhage, are at increased risk of developing CP, as well as children with PVL, both cystic and non-cystic.
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144
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Roro EM, Tumtu MI, Gebre DS. Predictors, causes, and trends of neonatal mortality at Nekemte Referral Hospital, east Wollega Zone, western Ethiopia (2010-2014). Retrospective cohort study. PLoS One 2019; 14:e0221513. [PMID: 31596859 PMCID: PMC6785121 DOI: 10.1371/journal.pone.0221513] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2019] [Accepted: 08/08/2019] [Indexed: 11/18/2022] Open
Abstract
Background Neonatal mortality is a significant contributor to infant mortality. Causes and predictors of neonatal death are known to vary in different settings and across different contexts. This study aimed to assess predictors, causes, and trends of neonatal mortality amongst neonates admitted to Nekemte Referral Hospital neonatal unit between 2010–2014. Methods Retrospective data was collected for 2090 live born neonates admitted to the neonatal intensive care unit of Nekemte Referral Hospital by reviewing records between 2010 to 2014. Variables were collected from the neonatal registration book and patient card on the predictors, causes, and trends of neonatal death using a standard checklist developed by the World Health Organization (WHO). Data was analyzed using Epi info version 3.5.1, and SPSS version 25 for windows. The level of significance was set at P<0.05 with the corresponding confidence intervals at 95%. A logistic regression model was used for analysis and to control for confounders. Microsoft Excel 2007 was used to construct the trend analysis. Results There were 183 deaths in the cohort equivalent to 8.8% of deaths among total admitted neonates during the study period. Early neonatal deaths accounted for 8% and late neonatal deaths accounted for 0.71% of deaths among total admitted neonates. Main predictors identified for an increased risk of neonatal mortality were; neonates from rural residents [AOR 1.35, (95% CI, 1.35–1.87)], birth order of greater than five [AOR 5.10, (95% CI, 1.15–22.63)], home delivery [AOR 3.41, (95% CI, 2.24–5.19)], very low birth weight [AOR 6.75, (95% CI, 3.63–12.54)] and low birth weight [AOR 2.81, (95% CI, 1.95–4.05)] and inability to cry at birth [AOR 2.21, (95% CI, 1.51–3.22)]. The trend analysis showed a sharp fall for the neonatal mortality over the last five years with a mean reduction of 16%. Conclusions Data from the Nekemte Referral Hospital Neonatal Intensive Care Unit analysis revealed majority of the deaths were occurred during early neonatal period. The main predictors of neonatal mortality identified from this study needs strengthening an appropriate public health intervention through addressing antenatal care, curbing home delivery.
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Affiliation(s)
- Elias Merdassa Roro
- Department of Public Health, Institute of Health Sciences, Wollega University, Nekemte, Oromia, Ethiopia
- * E-mail: ,
| | - Meseret Itana Tumtu
- Department of Public Health, Institute of Health Sciences, Wollega University, Nekemte, Oromia, Ethiopia
- Nekemte Polly Clinic, Nekemte Town, Oromia, Ethiopia
| | - Dejene Seyoum Gebre
- Department of Public Health, Institute of Health Sciences, Wollega University, Nekemte, Oromia, Ethiopia
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145
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Abstract
The outbreak of Zika in Brazil almost 3 years ago had harmful medical, financial, and social consequences for children and their families. It also significantly increased the statistics of Brazilian children with disabilities being followed up in rehabilitation centers. Actions promoting the use of the International Classification of Functioning, Disability and Health (ICF) framework are encouraged in view of the complex health needs identified in this population, which cover all areas of functioning, and gain special relevance when it comes to a vulnerable context. This perspective article discusses the challenges related to the implementation of the ICF in rehabilitation services for children with congenital syndrome.
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146
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Prevalence of spontaneous, induced labour or planned caesarean section and factors associated with caesarean section in low-risk women in southern Brazil. Midwifery 2019; 79:102530. [PMID: 31479799 DOI: 10.1016/j.midw.2019.102530] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2018] [Revised: 08/12/2019] [Accepted: 08/15/2019] [Indexed: 11/20/2022]
Abstract
OBJECTIVES This study aimed to examine the prevalence of spontaneous labour, induced labour and planned caesarean section in low-risk women; to identify the contribution of each group to the overall caesarean section rate; and to estimate factors associated with caesarean section in low-risk women according to spontaneous labour, induced labour and planned caesarean section. DESIGN Cross-sectional hospital-based study of postpartum women and newborns, using data from the survey Birth in Brazil, Southern region. In the sample of 2,668 low-risk women, a descriptive analysis was undertaken and a Multinomial Logistic Regression model was applied to verify associations among caesarean section and spontaneous labour, induced labour and planned caesarean section in comparison with vaginal birth. MEASUREMENTS AND FINDINGS The results showed the prevalence of spontaneous labour (48.0%), induced labour (14.0%) and planned caesarean sections (38.0%); these frequencies contributed to an overall caesarean section rate of 50.5%. Obstetric characteristics like previous vaginal birth or previous caesarean section were differentially associated with caesarean section, independently of the labour. Caesarean section without labour was significantly associated with age ≥ 35 years (ORadj 5.45 95%CI 3.16-9.39), economic class A and B (ORadj 3.10 95%CI 1.92-4.99), pregnancy between 37 and 38 weeks (ORadj 1.65 95%CI 1.22-2.24), same obstetrician in prenatal and childbirth (ORadj 13.83 95%CI 8.85-21.61) and private payment source at birth (ORadj 11.50 95%CI 6.64-19.93). KEY CONCLUSION For low-risk women in Southern Brazil, the results identify high planned caesarean section rates, not associated with socioeconomic, obstetric, institutional or prenatal factors that justify these rates.
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147
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do Nascimento Chofakian CB, Moreau C, Borges ALV, dos Santos OA. Contraceptive discontinuation: frequency and associated factors among undergraduate women in Brazil. Reprod Health 2019; 16:131. [PMID: 31464640 PMCID: PMC6714454 DOI: 10.1186/s12978-019-0783-9] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2018] [Accepted: 07/28/2019] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND In Brazil, high contraceptive prevalence rates coexist with high rates of unintended pregnancies. Contraceptive discontinuation may explain this context, but few studies have focused on highly educated young women in countries with low unmet need for modern contraception. This paper explores frequency and associated factors of contraceptive discontinuation among undergraduate students in Brazil within 12-months. METHODS This retrospective cohort study was conducted among a probability sample of 1679 undergraduates of São Paulo University. Data were collected online using a contraceptive calendar. We examined factors related to monthly discontinuation of oral pills and male condoms using Generalized Estimating Equation models. RESULTS Altogether, 19% of oral pill users and 48% of male condom users discontinued their method for method-related reasons within 12-months, and 18% of oral pill users and 15% of male condom users abandoned/or switched to less effective methods. Women in casual relationships were at increased odds of oral pill (OR = 1.4 [1.1-1.8]) and male condom discontinuation (OR = 1.3 [1.0-1.7]), and at increased odds of switching from oral pill to less effective or no method (OR = 1.4 [1.1-1.7]). Other associated factors were method specific. Women from lower socioeconomic status or who had multiple lifetime partners were more likely to discontinue or abandon the oral pill, while more sexually experienced women were less likely to discontinue the male condom. CONCLUSION Frequent method discontinuation in Brazil calls for greater attention to the difficulties women face when using short acting methods. Discontinuation was associated with type of partner and sexual experience highlighting the changing contraceptive needs of women at the early stages of their professional careers.
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Affiliation(s)
- Christiane Borges do Nascimento Chofakian
- Direct-Entry Midwifery Program, School of Arts, Sciences and Humanities of the University of São Paulo, Av. Arlindo Bettio, 1000 – Ermelino Matarazzo, São Paulo, São Paulo 03828-000 Brazil
| | - Caroline Moreau
- Department of Population, Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD USA
- Gender, sexual and reproductive health, CESP Centre for research in Epidemiology and Population Health, U1018, Inserm, F-94807 Le Kremlin-Bicêtre, France
| | - Ana Luiza Vilela Borges
- Department of Public Health Nursing, University of São Paulo School of Nursing, São Paulo, Brazil
| | - Osmara Alves dos Santos
- Department of Public Health Nursing, University of São Paulo School of Nursing, São Paulo, Brazil
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148
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Raupp L, Cunha GM, Fávaro TR, Santos RV. [Basic sanitation and inequalities in color/race in urban households with under-five children, with a focus on the indigenous population]. CAD SAUDE PUBLICA 2019; 35Suppl 3:e00058518. [PMID: 31433031 DOI: 10.1590/0102-311x00058518] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2018] [Accepted: 02/26/2019] [Indexed: 05/30/2023] Open
Abstract
This study aimed to analyze the presence of basic sanitation services in households with children under five years of age located in urban areas of Brazil, with a focus on indigenous children. This cross-sectional study was based on data from the 2010 Population Census. We calculated the rates of households with running water (public system), sewage disposal (public system or septic tanks), and garbage collection (directly or via public dumpsters). Multiple logistic regression (MLR) models were used to estimate associations between color/race and presence of sanitation services, based on odds ratios (OR). The study considered Brazil's urban metropolitan areas and stratified the results by major geographic region. Significance was set at 5%. The lowest frequencies were for sewage disposal, and all the rates were lower for indigenous people. MLR analyses included 29 comparisons (48.3%) in which households with indigenous children (compared to other color/race categories) were at a disadvantage, especially in the South of Brazil, where all comparisons were negative for indigenous households. Similar results appeared in metropolitan areas. The results thus suggest inequalities basic sanitation services based on color/race, where indigenous people are generally at a disadvantage, especially in the South of Brazil. Given the relationship between sanitation and health, as already demonstrated in the literature, these results can partly explain the low health levels in indigenous children in Brazil.
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Affiliation(s)
- Ludimila Raupp
- Pontifícia Universidade Católica do Rio de Janeiro, Rio de Janeiro, Brasil
| | - Geraldo Marcelo Cunha
- Escola Nacional de Saúde Pública Sergio Arouca, Fundação Oswaldo Cruz, Rio de Janeiro, Brasil
| | | | - Ricardo Ventura Santos
- Escola Nacional de Saúde Pública Sergio Arouca, Fundação Oswaldo Cruz, Rio de Janeiro, Brasil
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Silva TPRD, Carmo ASD, Novaes TG, Mendes LL, Moreira AD, Pessoa MC, Cosenza L, Pereira JFC, Matozinhos FP. Hospital-acquired conditions and length of stay in the pregnancy and puerperal cycle. Rev Saude Publica 2019; 53:64. [PMID: 31432929 PMCID: PMC6705548 DOI: 10.11606/s1518-8787.2019053000688] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2018] [Accepted: 10/02/2018] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE To analyze the impact of the Hospital-Acquired Conditions (HAC) in women in the puerperal and pregnancy cycle during length of stay. METHODS This cross-sectional study was conducted with 113,456 women, between July 2012 and July 2017, in Brazil's national hospitals of the supplementary healthcare networks and philanthropists accredited to the Unified Health System (SUS). Data on hospital discharges were collected using the Diagnosis-Related Groups (DRG Brasil®) system. All DRGs of the major diagnostic category 14 (MDC14), including pregnancy, childbirth and puerperium, were included. The impact of HAC on length of stay was estimated by Student's t-test, and the effect size by Cohen's d, which allows to assess clinical relevance. RESULTS The most prevalent diagnostic categories related to MDC14 were vaginal and cesarean deliveries without complicating diagnoses, both at institutions accredited to SUS and those for supplementary health care. The prevalence of HAC was 3.8% in supplementary health and 2.5% in SUS. Hospitals providing services to supplementary health care providers had a longer length of stay considering HAC for patients classified as DRG: cesarean section with complications or comorbidities at admission (p < 0.001; Cohen's d = 0.74), cesarean section without complications or comorbidities at admission (p < 0.001, Cohen's d = 0.31), postpartum and post abortion without listed procedure (p < 0.001, Cohen's d = 1.05), and other antepartum diagnoses with medical complications (p < 0.001; Cohen's d = 0.77). CONCLUSIONS This study showed that the prevalence of HAC was low both in the institutions accredited to attend by SUS and in those of supplementary health; however, its presence contributes to increasing the length of stay in cases of cesarean sections without complications or comorbidities in supplementary health institutions.
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Affiliation(s)
- Thales Philipe Rodrigues da Silva
- Universidade Federal de Minas Gerais. Faculdade de Medicina. Programa de Pós-Graduação em Ciências da Saúde. Belo Horizonte, MG, Brasil
| | - Ariene Silva do Carmo
- Universidade Federal de Minas Gerais. Faculdade de Medicina. Programa de Pós-Graduação em Ciências da Saúde. Belo Horizonte, MG, Brasil
| | - Taiane Gonçalves Novaes
- Universidade Federal de Viçosa. Departamento de Nutrição. Programa de Pós-Graduação em Saúde e Nutrição de Grupos Populacionais. Viçosa, MG, Brasil
| | - Larissa Loures Mendes
- Universidade Federal de Minas Gerais. Escola de Enfermagem. Departamento de Nutrição. Belo Horizonte, MG, Brasil
| | - Alexandra Dias Moreira
- Universidade Federal de Minas Gerais. Escola de Enfermagem. Departamento de Enfermagem Materno-Infantil e Saúde Pública. Belo Horizonte, MG, Brasil
| | - Milene Cristine Pessoa
- Universidade Federal de Minas Gerais. Escola de Enfermagem. Departamento de Nutrição. Belo Horizonte, MG, Brasil
| | - Luna Cosenza
- Instituto de Acreditação e Gestão em Saúde (IAG Saúde). Belo Horizonte, MG, Brasil
| | | | - Fernanda Penido Matozinhos
- Universidade Federal de Minas Gerais. Escola de Enfermagem. Departamento de Enfermagem Materno-Infantil e Saúde Pública. Belo Horizonte, MG, Brasil
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150
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Farias YN, Leite IDC, Siqueira MAMTD, Cardoso AM. [Ethnic and racial inequalities in hospital admissions due to avoidable causes in under-five Brazilian children, 2009-2014]. CAD SAUDE PUBLICA 2019; 35Suppl 3:e00001019. [PMID: 31433026 DOI: 10.1590/0102-311x00001019] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2019] [Accepted: 04/02/2019] [Indexed: 11/22/2022] Open
Abstract
There has been a global increase in hospital admissions for primary care-sensitive conditions (PCSCs) as an indicator of effectiveness in primary health care. This article analyzes ethnic and racial inequalities in cause-related hospitalizations in under-five children in Brazil as a whole and the country's five major geographic regions, with an emphasis on PCSCs and acute respiratory infections (ARIs). Using data from the Hospital Information Systems of the Brazilian Unified National Health System (SIH/SUS), 2009-2014, the authors calculated proportions, rates, and rate ratios for PCSCs, adjusted by sex and age after multiple imputation of missing data on color/race. The principal causes of hospitalization were respiratory tract infections (37.4%) and infectious and parasitic diseases (19.3%), and indigenous children were proportionally the most affected. Crude PCSC rates (per 1,000) were highest in indigenous children (97.3; 95%CI: 95.3-99.2), followed by brown or mixed-raced children (40.0; 95%CI: 39.8-40.1), while the lowest rates were in Asiandescendant children (14.8; 95%CI: 14.1-15.5). The highest adjusted rate ratios for PCSCs were seen among indigenous children compared to white children - 5.7 (95%CI: 3.9-8.4) for Brazil as a whole, reaching 5.9 (95%CI: 5.0-7.1) and 18.5 (95%CI: 16.5-20.7) in the North and Central, respectively, compared to white children. ARIs remained as important causes of pediatric hospitalizations in Brazil. Alarming ethnic and racial inequalities were observed in PCSCs, with indigenous children at a disadvantage. Improvements are needed in living conditions, sanitation, and subsistence, as well as guaranteed timely access to high-quality primary health care in the more vulnerable population groups, especially the indigenous peoples of the North and Central, in order to mitigate the health inequalities and meet the guidelines of the SUS and the Brazilian Constitution.
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Affiliation(s)
| | - Iuri da Costa Leite
- Escola Nacional de Saúde Pública Sergio Arouca, Fundação Oswaldo Cruz, Rio de Janeiro, Brasil
| | | | - Andrey Moreira Cardoso
- Escola Nacional de Saúde Pública Sergio Arouca, Fundação Oswaldo Cruz, Rio de Janeiro, Brasil
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