Medicine use from birth to age two years: the 2004 Pelotas (Brazil) Birth Cohort study

Suspected adverse drug reactions reported for Brazilian children: cross-sectional study

OBJECTIVE

To assess spontaneous reports of suspected adverse drug reactions in children aged 0-12 years from the Brazilian Health Regulatory Agency between 2008 and 2013.

METHODS

A cross-sectional study on suspected adverse drug reactions reports related to medicines and health products in children was carried out for a six-year period (2008-2013). Year of report, origin of report by Brazilian state, gender, age, suspected drug, adverse reaction description and seriousness were included in the analysis. The data obtained was compared to the number of pediatric beds in health services and to global data from the VigiBase (World Health Organization).

RESULTS

A total of 3330 adverse drug reactions were reported in children in Brazil in the investigated period (54% were in boys). About 28% of suspected adverse drug reactions reports involved 0 to 1-year-old children. Almost 40% of reports came from the Southeast region. Approximately 60% were classified as serious events. There was death in 75 cases. Nearly 30% of deaths involved off-label use; 3875 medicines (465 active substances) were considered suspected drugs. Anti-infective (vancomycin, ceftriaxone, oxacillin, and amphotericin), nervous system (metamizole) and alimentary tract and metabolism medicines were more frequent in reports.

CONCLUSIONS

The distribution of suspected adverse drug reactions reports by sex and age group corresponded to the profile of children hospitalized in Brazil. Data about seriousness and medicines reported may be useful to encourage regulatory actions and improve the safe use of medicines in children.

USE OF DRUGS IN CHILDREN AGED ZERO TO FIVE YEARS OLD IN TUBARÃO, SANTA CATARINA, BRAZIL

Objective:

To analyze the context of drug use in children aged zero to five years old.

Methods:

Cross-sectional study based on interviews conducted at home with caregivers (parents, uncles or grandparents) of the children enrolled in ten Family Health Strategy units across different geographical points of the city of Tubarão, Santa Catarina, Brazil.

Results:

A total of 350 caregivers were interviewed, whose children’s mean age was 2.6 years. Of these, 56.9% had used at least one drug in the 15 days prior to the interview, 31.1% had been exposed to self-medication and 35.7% had used at least one medication obtained by current prescription. The use of medication was associated with the age range up to 24 months, periodic consultation with pediatricians and diagnosis of chronic and acute diseases. Among medicated children, 19.1% inappropriately had been exposed to at least one medication (considering dose, dose interval or period of treatment). Regarding medication storage, 55.2% of interviewees stored them in unsafe places that could be accessed by children and 32.0% in inappropriate places, with exposure to light, heat or humidity. Moreover, 45.2% of the interviewees stored drugs out of their packages, 38.9% without secondary packaging, and 1.6% of drugs had expired date.

Conclusions:

Drug use is high among children in this age range, and actions aimed at the safe and rational use of these substances in this population should be encouraged.

Iron salts and vitamins: use, purchase and sources of obtainment among children in Brazil

To verify the prevalence of use, purchase and sources of iron salts and vitamins by children aged from 0 to 12 years in Brazil. Population-based transversal study (Brazilian National Survey on Access, Utilization, and Promotion of Rational Use of Medicines - PNAUM), including 7,528 children up to 12 years of age. Information was obtained through questionnaires answered by the children’s tutors, about the use of iron salts and vitamins 15 days before the interview; forms of financing, and sources of obtainment, sociodemographic characteristics, and presence of chronic disease. Descriptive and bivariate analyses were performed and the main variables were expressed by relative frequencies and 95% confidence intervals (95%CI). The prevalence of use of iron salts was 1.6% (95%CI: 1.2-2.1), with higher prevalence among children under 1 year old (8.5%; 95%CI: 6.3-11.5) and residents of the southeastern region (2.3%; 95%CI: 1.5-3.4). Prevalence of use of vitamins was 4.8% (95%CI: 4.2-5.6), with higher prevalence among children under 1 year old (24.3%; 95%CI: 20.3-28.7) and residents of the northern region (8.6%; 95%CI: 6.2-11.7). Purchase occurred by direct reimbursement for 41.6% (95%CI: 27.9-56.7) of the iron salts, and for 82.4% (95%CI: 76.3-87.2) of the vitamins. The iron salts were predominantly obtained from SUS pharmacies (51.5%; 95%CI: 36.4-66.4), and the vitamins from commercial pharmacies (80.6%; 95%CI: 77.4-85.6). The results suggested the use of iron salts in the Brazilian pediatric population was low, with reduction in use as age increased, regional differences and free-of-charge obtainment, predominantly from SUS.

Use of medicines and other products for therapeutic purposes among children in Brazil

OBJECTIVE

To assess the prevalence of the use of medicines and other products for therapeutic purposes in the Brazilian pediatric population and test whether demographic, socioeconomic and health factors are associated with use.

METHODS

A cross-sectional population-based study (National Survey on Access, Use and Promotion of Rational Use of Medicines - PNAUM), including 7,528 children aged 12 or younger, living in urban areas in Brazil. Medicine use to treat chronic or acute diseases was reported by the primary caregiver present at the household interview. Associations between independent variables and medicine use were investigated by Poisson regression.

RESULTS

The overall prevalence of medicine use was 30.7% (95%CI 28.3-33.1). The prevalence of medicine use for chronic diseases was 5.6% (95%CI 4.7-6.7) and for acute conditions, 27.1% (95%CI 24.8-29.4). The factors significantly associated with overall use were five years old or under, living in the Northeast region, having health insurance and using health services in the last 12 months (emergency visits and hospitalizations). The following were associated with drug use for chronic diseases: age ≥ 2 years, Southeast and South regions, and use of health services. For drug use in treating acute conditions, the following associated factors were identified: ≤ 5 years, North, Northeast or Midwest regions, health insurance, and one or more emergency visits. The most commonly used drugs among children under two years of age were paracetamol, ascorbic acid, and dipyrone; for children aged two years or over they were dipyrone, paracetamol, and amoxicillin.

CONCLUSIONS

The use of medicine by children is considerable, especially in treating acute medical conditions. Children using drugs for chronic diseases have a different demographic profile from those using drugs for acute conditions in relation to gender, age, and geographic region.

OBJETIVO

Estimar a prevalência de uso de medicamentos e outros produtos com finalidade terapêutica na população pediátrica brasileira e testar se fatores demográficos, socioeconômicos e médicos estão associados ao uso.

MÉTODOS

Estudo transversal de base populacional (Pesquisa Nacional sobre Acesso, Utilização e Promoção do Uso Racional de Medicamentos - PNAUM), incluindo 7.528 crianças com 12 anos ou menos de idade, residentes na zona urbana do território brasileiro. O uso de medicamentos para tratar doenças crônicas ou agudas foi referido pelo principal cuidador da criança presente na entrevista domiciliar. Associações entre as variáveis independentes e o uso de medicamentos foram investigadas por meio de regressão de Poisson.

RESULTADOS

A prevalência de uso global de medicamentos foi de 30,7% (IC95% 28,3-33,1). A prevalência de uso de medicamentos para doenças crônicas foi de 5,6% (IC95% 4,7-6,7) e para condições agudas, 27,1% (IC95% 24,8-29,4). Os fatores significativamente associados com o uso global foram ter no máximo cinco anos de idade, residir na região Nordeste, ter plano de saúde e utilizar serviços de saúde nos últimos 12 meses (consultas de emergência e internações). Associaram-se ao uso de medicamentos para doenças crônicas: idade ≥ 2 anos, regiões Sudeste e Sul e utilização de serviços de saúde. Para o uso de medicamentos em condições agudas, foram identificados os seguintes fatores associados: ≤ 5 anos, Norte, Nordeste ou Centro-Oeste, plano de saúde e uma ou mais consultas de emergência. Os medicamentos com maior prevalência de uso pelas crianças menores de dois anos foram paracetamol, ácido ascórbico e dipirona; nas crianças com 2 ou mais anos, foram dipirona, paracetamol e amoxicilina.

CONCLUSÕES

O uso de medicamentos na população infantil é substancial, principalmente no tratamento de condições médicas agudas. As crianças usuárias de medicamentos para doenças crônicas apresentam perfil demográfico diferente das usuárias de medicamentos para condições agudas, em relação ao sexo, à idade e à região geográfica.

Determinants of out-of-pocket health expenditure on children: an analysis of the 2004 Pelotas Birth Cohort

Background

The present study aimed to examine the impact of socioeconomic, demographic, and health status-related factors on out-of-pocket expenditure on health care for children.

Methods

Data were obtained from a birth cohort study conducted in the city of Pelotas, state of Rio Grande do Sul (RS), southern Brazil, in 2004. The final sample is a result of adjusts made in order to keep in the analysis only those that attended to 3 follow-ups (at 12, 24 and 48 months of age). Estimates were carried out using the Panel Data Tobit Model with random effects.

Results

The study showed that expenditure on medicines was 20 % less likely in those considered healthy children by their mothers and, if there was any expenditure with healthy children, the expected expenditure was reduced by 58 %. A 1 % increase in household income increased the expected expenditure on medicines by 16 %, and by 23 % in children with private health insurance coverage.

Conclusions

All types of health care expenditures examined were higher for children covered by private health insurance. Although total health care expenditure was higher for children of better-off families, it represented a lower share of these families’ income evidencing income inequality in health care expenditures.

Electronic supplementary material

The online version of this article (doi:10.1186/s12939-015-0180-0) contains supplementary material, which is available to authorized users.

Prevalence of self-medication for skin diseases: a systematic review

Self-medication is the selection and use of drugs without medical prescription, to treat diseases or for symptomatic relief. This article is a systematic review on self-medication in skin diseases. A search was conducted on Virtual Health Library and PubMed databases using predetermined descriptors. Two researchers performed the article selection process independently, with the degree of inter-observer agreement measured by the kappa index. The prevalence of self-medication ranged from 6.0 to 45.0%. Topical corticosteroids were the most commonly used therapeutic strategies for self-medication, as found in the reviewed articles. This study revealed that published data on self-medication in dermatology are scarce, although the findings showed that it was a common practice.

Medication use among children 0-14 years old: population baseline study

OBJECTIVE

Determine the prevalence of medication use in children and adolescents in 20 municipalities of Vale do Jequitinhonha, Minas Gerais-Brazil, showing the main groups and variables that may have influenced use.

METHODS

Descriptive population-based survey sample of 555 interviews, selected by simple random cluster sampling of 137 census tracts. Inclusion criteria were age ≤ 14 years, mandatory interview with the legal guardians, and regardless of having received medications. Regarding the usage pattern, participants were divided into two groups: consumption and non-consumption of drugs. A descriptive analysis of the variables and tests of association were performed.

RESULTS

The prevalence of drug consumption was 56.57%, and 42.43% showed no consumption. The use of medicinal plants was 72.9% for drug users and 74.3% for non-users. The health conditions for consumption were cough, common cold, flu, nasal congestion or bronchospasm (49.7%), fever (5.4%), headache (5.4%), diarrhea, indigestion, and abdominal colic (6.7%). In cases of self-medication, 30.57% of the drugs were given by the mother, and 69.42% were prescription drugs. Self-medication was prevalent using paracetamol (30.2%), dipyrone (20.8%), and cold medicine (18.8%). There was increased use of analgesics/antipyretics, followed by respiratory medications, systemic antibiotics, histamine H1 antagonists, and vitamins/antianemics.

CONCLUSIONS

The prevalence of drugs use in children was high, indicating the need for formulating educational programs aiming at the awareness of caregivers regarding rational use.

Cohort profile update: 2004 Pelotas (Brazil) Birth Cohort Study. Body composition, mental health and genetic assessment at the 6 years follow-up

This is an update of the 2004 Pelotas Birth Cohort profile, originally published in 2011. In view of the high prevalence of overweight and mental health problems among Brazilian children, together with the availability of state-of-the-art equipment to assess body composition and diagnostic tests for mental health in childhood, the main outcomes measured in the fifth follow-up (mean age 6.8 years) included child body composition, mental health and cognitive ability. A total of 3722 (90.2%) of the original mothers/carers were interviewed and their children examined in a clinic where they underwent whole-body dual X-ray absorptiometry (DXA), air displacement plethysmography and a 3D photonic scan. Saliva samples for DNA were obtained. Clinical psychologists applied the Development and Well-Being Assessment questionnaire and the Wechsler Intelligence Scale for Children to all children. Results are being compared with those of the two earlier cohorts to assess the health effects of economic growth and full implementation of public policies aimed at reducing social inequalities in the past 30 years. For further information visit the programme website at [http://www.epidemio-ufpel.org.br/site/content/coorte_2004/questionarios.php]. Applications to use the data should be made by contacting 2004 cohort researchers and filling in the application form available at [http://www.epidemio-ufpel.org.br/site/content/estudos/formularios.php].

Erosive and cariogenicity potential of pediatric drugs: study of physicochemical parameters

Background

Pediatric medications may possess a high erosive potential to dental tissues due to the existence of acid components in their formulations. The purpose was to determine the erosive and cariogenic potential of pediatric oral liquid medications through the analysis of their physicochemical properties in vitro.

Methods

A total of 59 substances were selected from the drug reference list of the National Health Surveillance Agency (ANVISA), which belong to 11 therapeutic classes, as follows: analgesics, non-steroidal anti-inflammatory, corticosteroids, antihistamines, antitussives, bronchodilators, antibacterials, antiparasitics, antiemetics, anticonvulsants and antipsychotics. Measurement of pH was performed by potentiometry, using a digital pH meter. For the Total Titratable Acidity (TTA) chemical assay, a 0.1 N NaOH standard solution was used, which was titrated until drug pH was neutralized. The Total Soluble Solids Contents (TSSC) quantification was carried out by refractometry using Brix scale and the analysis of Total Sugar Content was performed according to Fehling’s method. In addition, it was analyzed the information contained in the drug inserts with regard to the presence of sucrose and type of acid and sweetener added to the formulations.

Results

All drug classes showed acidic pH, and the lowest mean was found for antipsychotics (2.61 ± 0.08). There was a large variation in the TTA (0.1% - 1.18%) and SST (10.44% - 57.08%) values. High total sugar contents were identified in the antitussives (53.25%) and anticonvulsants (51.75%). As described in the drug inserts, sucrose was added in 47.5% of the formulations, as well as citric acid (39.0%), sodium saccharin (36.4%) and sorbitol (34.8%).

Conclusion

The drugs analyzed herein showed physicochemical characteristics indicative of a cariogenic and erosive potential on dental tissues. Competent bodies’ strategies should be implemented in order to broaden the knowledge of health professionals, drug manufacturers and general consuming public about the risks from the consumption of medicines potentially harmful to dental tissues.

Automedicação em crianças de zero a cinco anos: fármacos administrados, conhecimentos, motivos e justificativas

Realizou-se a análise dos fármacos administrados, conhecimentos, motivos e justificativas dos pais e/ou responsáveis em relação à automedicação em crianças. Trata-se de um estudo descritivo, desenvolvido em uma Estratégia de Saúde da Família de um município do interior do estado de Minas Gerais, do qual fizeram parte pais e/ou responsáveis pelas crianças em faixa etária de zero a cinco anos, no período de um mês, atingindo o quantitativo de 50 indivíduos. Destacaram-se a autoadministração dos fármacos Dipirona, Paracetamol e xaropes expectorantes. Foram registrados os conhecimentos errôneos 32(64%), seguidos dos parciais 11(22%) e corretos 7(14%). Como motivos, foram constatados os sintomas de febre, com 29 (58%) dos relatos e as justificaticas foram o costume de administrar tais medicamentos e o fato de já estarem disponíveis no domicílio. Faz-se necessária a implementação de estratégias objetivando conscientizar os pais e/ou responsáveis acerca dos problemas oriundos da automedicação.

Therapeutic procedures and use of alternating antipyretic drugs for fever management in children

OBJECTIVE

The evidence on the effectiveness of alternating antipyretics in fever management is scarce and indicates clinically negligible differences. The present study aimed to describe therapeutic procedures and the use of alternating antipyretics in children, and to evaluate associated factors.

METHODS

This was a cross-sectional study with 692 children aged 0 to 6 years, living in Southern Brazil. Household interviews of the children's caregivers were conducted through cluster sampling using a structured questionnaire. A descriptive analysis was carried out, and the association between the use of alternating antipyretics and sociodemographic factors was evaluated. A total of 630 cases were analyzed (91.0%), corresponding to children with a history of fever.

RESULTS

Approximately 73% of caregivers reported that the first measure adopted during the last fever episode was the administration of medication. The mean temperature considered as fever by caregivers was 37.4°C, and as high fever, 38.7°C. The use of alternating antipyretic therapy was reported by 26.7% of respondents, justified by the lack of response to monotherapy and medical indication, in most cases. The drugs most often used were dipyrone and paracetamol. Children whose primary caregiver was a parent with higher socioeconomic status and higher educational level received more alternating medications. Approximately 70% of the doses used were below the minimum recommended dose for the treatment of fever.

CONCLUSIONS

The use of medication to control fever is a common practice, including alternating antipyretic regimens. Most caregivers consider as fever temperatures lower than those established and they reported lack of response to monotherapy and medical indication as the main reasons for alternating medication.

Tracking of medicine use and self-medication from infancy to adolescence: 1993 Pelotas (Brazil) birth cohort study

PURPOSE

To track the use of medicine and self-medication from infancy to adolescence.

METHODS

All newborns in the city of Pelotas, Brazil, were monitored and enrolled in the 1993 Pelotas (Brazil) Birth Cohort Study. Subsamples of the cohort were visited at 1, 3, and 6 months and at 1 and 4 years of age. At 11 and 15 years of age, all cohort members were sought. In each of these visits, information on medicine use in the 15 days before the interview was collected. Two outcomes were analyzed: prevalence of medicine use and prevalence of self-medication.

RESULTS

Prevalence of medicine use in the first year of life ranged from 52.0% to 68.6%. From 4 to 15 years of age, the prevalence decreased, ranging from 30.9% to 37.2%. At age 15, girls presented a 33% higher prevalence of medicine use than boys. The proportion of self-medication ranged from 12.4% to 29.0% and was higher in girls aged 11 and 15 years than boys of the same age. In all follow-up periods, use of medicines was significantly higher among children who used medicines in the earlier period. Prevalence of self-medication was higher among those who were self-medicated in the previous periods.

CONCLUSIONS

Tracking studies are important to public health because they can predict future behavior by analyzing past behavior, thus helping in designing preventive actions. In this study, previous use of medicines predicts future use, thus creating an opportunity to plan actions that promote the rational use of medicines.

Automedicação em menores de cinco anos em municípios do Pará e Piauí: prevalência e fatores associados

OBJETIVOS: medir a prevalência e identificar fatores associados à automedicação em crianças menores de cinco anos nos municípios de Caracol no Estado do Piauí, e Garrafão do Norte no Pará. MÉTODOS: utilizando-se de delineamento transversal, amostragem sistemática e utilização de questionário padrão por meio de visita domiciliar, foram investigadas diversas características das mães, das famílias e das crianças. Utilizou-se teste do qui-quadrado para comparar proporções e regressão de Poisson com ajuste robusto da variância na análise multivariável. RESULTADOS: dentre as 590 crianças estudadas em Caracol e 1081 em Garrafão, 30% e 25% haviam sido automedicadas nos últimos 15 dias, respectivamente. Após análise ajustada para diversas variáveis confundidoras, o fato de não conseguir atendimento para o filho doente nos últimos 15 dias nos dois municípios, assim como de residir há mais de 1 km dos serviços de saúde em Caracol e de a mãe exercer trabalho remunerado nos últimos 12 meses em Garrafão mostraram-se significativamente associadas à automedicação entre menores de cinco anos. CONCLUSÕES: a prevalência de automedicação por parte das mães para menores de cinco anos nos municípios estudados, apesar de inferior à observada em outras localidades brasileiras, decorreu, sobretudo, da dificuldade de realização de consulta médica.