Temporal and spatial distribution trends of polio vaccine coverage in less than one-year old children in Brazil, 2011-2021

BACKGROUND

Low polio vaccine coverage can result in the spread of Poliovirus to areas free from viral circulation. This study analyzed the temporal trends and spatial distribution of polio vaccine coverage in one year-old children in Brazil, between 2011 and 2021.

METHODS

This was an ecological, time-series study (2011 to 2021) with annual vaccine coverages against poliomyelitis, extracted from the Information System of the National Immunization Program from the 26 States and the Distrito Federal (DF). The percentage reductions in vaccination coverage in Brazil and in the Regions were calculated. Prais-Winsten regression models were used to analyze time series for the Regions and States, and spatial analysis identified the distribution of clusters (high-high; low-low; high-low and low-high) of vaccination coverages across Brazilian municipalities, using a 5% significance level.

RESULTS

From 2011 to 2021, the coverage of polio vaccines decreased by 29,9%. There was a progressive increase observed in clusters resulting in low vaccination coverages (140 low-low Brazilian municipalities in 2011 vs. 403 in 2021), mostly reported in the North and Northeast regions of the country. There was a downward trend in vaccination coverages in 24 of the 26 States and DF (p ≤ 0.05).

CONCLUSIONS

The reduction in polio vaccine coverage, as observed in the North and Northeast regions of Brazil, may favor the spread of Poliovirus. Therefore, vaccination strategies should be prioritized for children residing in areas with sharp and recurrent declines in vaccination coverages, including travelers, migrants, and refugees.

Covid-19 pandemic impacts on follow-up of child growth and development

OBJECTIVE

To analyze the impact of the covid-19 pandemic on the use of primary health care services to follow-up the child growth and development in Brazil.

METHOD

A total of 7.9 million consultations of children (0–2 years old) across Brazil between March 2017 and May 2020 were studied. Differences between medians were analyzed using non-parametric tests, the Global Moran Index (I_GM) and the Local Indicators of Spatial Association.

RESULTS

During the initial period of the pandemic, the median number of consultations was significantly lower than the same period in previous years, reducing more than 50%. The drop in 2020, compared to 2019, ranged from 49% to 62.2% across all regions of the country, except the South. The percentage reduction registered in 2019–2020 showed significant spatial autocorrelation (I_GM = 0.20; p = 0.04), with the presence of low-low (states with reduction between 29% and 51%) and high-high (states with reduction between 55% and 69%) spatial clusters.

CONCLUSION

The covid-19 pandemic impacted the follow-up of child growth and development in primary health care services in Brazil, with a geographically uneven reduction.

Fatores socioculturais que contribuem para a qualidade de vida de cuidadores familiares de adultos dependentes de cuidados crônicos

Objetivo: explorar os fatores socioculturais que contribuem para a qualidade de vida de cuidadores familiares de adultos dependentes de cuidados crônicos no Brasil. Método: estudo qualitativo realizado de outubro de 2016 a março de 2017 em Belo Horizonte, Minas Gerais, Brasil. Vinte e cinco cuidadores familiares de adultos dependentes de cuidados crônicos foram entrevistados por dois pesquisadores por meio de visitas domiciliares. Foi utilizado um roteiro com sete questões abertas relacionadas ao processo de cuidar. As entrevistas foram gravadas em áudio, transcritas e, posteriormente, analisadas por meio da análise de conteúdo. O COREQ foi utilizado para adequação da qualidade estrutural do manuscrito. Resultados: os participantes do estudo relataram diferentes fatores socioculturais que contribuem para sua qualidade de vida. Esses fatores foram categorizados em três categorias principais: O impacto dos construtos socioculturais no processo de cuidar; O autocuidado e suas nuances: velhos desafios para os cuidadores; e Estado e cuidadores: desafios e possibilidades. Conclusões: a qualidade de vida do cuidador é influenciada por suas características e condições socioculturais, apresentando relação com seu modo de viver e de se expressar, sendo, portanto, passível de mudanças. O desenvolvimento de políticas sociais e de saúde para famílias cuidadoras é urgente para a prevenção da sobrecarga familiar e para a promoção de famílias sustentáveis que convivem com doenças crônicas não transmissíveis.

Availability of the Yellow Fever Vaccine in Primary Health Care Services in Brazil

Objectives

To analyze the availability of the Yellow Fever (YF) vaccine at Primary Health Care (PHC) services located in areas with vaccine recommendation in Brazil between two different periods.

Methods

Secondary data from the Program for Improving Access and Quality in PHC, with 13,666 services in 2013-14, and 19,125 in 2017-18, were used. A structured questionnaire was used for the data collection. Pearson’s chi-square and thematic cartographic maps were used to analyze the frequency of the YF vaccine, and Poisson regression with robust variances was used to analyze the associated factors.

Results

The overall frequency of PHC facilities with YF vaccine always available increased from 87.0% (CI 95%; 86.4-87.5) in 2013-14 to 89.7% (CI 95%; 89.2-90.1) in 2017-18. Facilities located in the South, Southeast, Midwest and Northern regions and in non-state capitals, as well as centers that had adequate facilities for vaccination actions, as well as an adey -50quate cold chain network, showed a greater prevalence of YF vaccine always available.

Conclusion

The frequency of a steady supply of YF vaccine available at PHC facilities, located in Areas with Routine Vaccination Recommendations, increased between 2013-14 and 2017-18. Geographical and structural characteristics related to vaccine actions at PHC facilities influenced access. The effective supply chain networks for the YF vaccine, together with adequate services at PHC facilities are essential to ensuring that the YF vaccine is always available.

Impact of the COVID-19 Pandemic on Human Papillomavirus Vaccination in Brazil

Objective: To analyze the number of applied HPV vaccine doses before (from April 2019 to March 2020) and after (from April 2020 to September 2020) social distancing measures in response to the COVID-19 pandemic in states and regions of Brazil. Methods: Ecological time-series study, using data from the Brazilian National Immunization Program (PNI). Using the Mann-Whitney test, we evaluated the difference between the median number of applied doses during the periods April 2019 to March 2020 and from April 2020 to September 2020. Spatial analysis identified clusters with a high or low percentage reduction in the median applied doses. Prais-Winsten regression models identified temporal trends in the applieddoses from both periods. Results: There was a significant reduction in the median HPV vaccine doses applied, formation of spatial clusters and, after a sharp drop in the number of applieddoses during the months following social distancing. There was a tendency to increase the applied vaccines doses. Conclusion: The COVID-19 pandemic resulted in reduction of the number of HPV vaccine doses applied as a possible effect of restrictive measures caused by the pandemic.

Motivation and difficulties to reduce or quit smoking

OBJECTIVE

To understand what factors motivate people to reduce or stop tobacco use and what difficulties they face in this process.

METHOD

Qualitative, empirical and interpretative research that used a focal group technique for data collection and Discourse Analysis as a theoretical reference for analysis.

RESULTS

The responses centered on the following aspects: motivation for reduction or cessation of smoking, family and community support received during treatment, benefits from cessation of tobacco, difficulties encountered and strategies for overcoming triggers.

FINAL CONSIDERATIONS

The results showed that the users expressed their desire for cessation of tobacco use and that to achieve this goal, family and group support, professional help and changing habits are key factors for this process.

[Estimated prevalence of hypertension and associated factors in Krenak indigenous adults in the state of Minas Gerais, Brazil]

This cross-sectional study in 2016 aimed to describe the estimated prevalence of systemic arterial hypertension and associated factors in Krenak adults and elderly in an indigenous community located along the Rio Doce in eastern Minas Gerais state, Brazil. We measured weight, height, waist circumference, systolic blood pressure, diastolic blood pressure, and capillary blood glucose. Sociodemographic and lifestyle information was obtained from a face-to-face questionnaire. Poisson regression models were constructed to estimate independent associations between the target variables and hypertension. Prevalence of hypertension was 31.2% (95%CI: 24.4-37.9) in Krenak indigenous. The final model showed an independent association with increasing age, abdominal obesity, and hyperglycemia. The results highlight the need for effective measures in prevention, diagnosis, and follow-up of modifiable risk factors for hypertension, since high prevalence of this condition was observed in the Krenak indigenous community.

Anthropometric changes and their effects on cardiometabolic risk factors in rural populations in Brazil

This article aims to evaluate associations between anthropometric changes in five years with lipid and blood pressure levels in Brazilian rural population. This longitudinal study evaluated 387 individuals aged 18 to 75 residents of two rural communities. Demographic, lifestyle, anthropometric, biochemical and hemodynamic characteristics were assessed in 2004 and repeated in 2009. Multivariate linear regression was used. Positive change in BMI was associated with increased diastolic blood pressure (DBP) (β = 0.07; 95%CI: 0.03-0.11), low-density lipoprotein (LDL-C) (increase of 0.01% to 10%: β = 0.08; 95%CI: 0.02-0.14, more than 10% increase: β = 0.09; 95%CI: 0.01-0.16) and low density lipoprotein/high density lipoprotein cholesterol ratio (LDL-C/HDL-C) (increase of 0.01% to 10%: β = 0.15; 95%CI: 0.06-0.25, more than 10% increase: β = 0.14; 95%CI: 0.02-0.25). Our results showed no association between positive changes in WC and lipid levels increase, only with blood pressure levels increase (SBP: β = 0.06; CI95%:0.02-0.10; DBP: β = 0.09; CI95%: 0.04;0.13). Positive changes in BMI are independent predictors of increased lipid and blood pressure levels and positive changes in WC of increased blood pressure.

Special attention to women experiencing high-risk pregnancy: Delivery, care assistance and neonatal outcomes in two Brazilian maternity wards

BACKGROUND

To compare two care models of high-risk pregnant women--a House for Pregnant Women, staffed by nurse-midwives, versus a traditional care model in a hospital maternity ward.

DESIGN

This was across-sectional study conducted in two reference maternity hospitals for high-risk pregnancies, in Belo Horizonte, Minas Gerais, Brazil. The sample consisted of 312 high-risk pregnant women consecutively admitted from January 1st to December 31^st, 2010, either to the House for Pregnant Women (n=247), or the hospital maternity ward (n=65). Gestational ages varied from 22 weeks to 36 weeks and six days. We measured individual, demographic, obstetric, labour and delivery variables, and newborn characteristics. For data analysis, we used descriptive, bivariate and multivariate statistics using Poisson regression, with a 5% significance level.

FINDINGS

At the conventional hospital maternity ward, more women had six or more antenatal exams, greater frequencies of diagnosis related to blood pressure, and a greater number of women underwent either a C-section or a vaginal delivery with an episiotomy and analgesia. At the House for Pregnant Women, the majority of the hospitalizations were related to preterm labour and premature rupture of membranes. There were no statistical differences in the newborn characteristics.

KEY CONCLUSIONS

The House for Pregnant Women care model, utilizing midwives was less interventionist, yet with results as favorable as in a conventional maternity hospital setting.

Food Patterns during An Economic Crisis among Pregnant Women in Purworejo District, Central Java, Indonesia

A cross-sectional study was conducted between 1996 and 1998. Six 24-hour recalls were performed during the second trimester of pregnancy among 450 women in Purworejo District, Central Java, Indonesia. The objectives of the study were to assess the food intake and food pattern among pregnant women before and during the economic crisis. Before the crisis, rich women had the highest intakes of animal foods, fats and oils, and sugar. Food intake among the urban poor and the rural landless poor subgroups was influenced by the emerging economic crisis. Although the price of rice increased, the intake of rice also increased among all subgroups. Rural poor women with access to rice fields increased their intake of rice and decreased their intake of nonrice staple foods (p < .05). There were significant decreases in the consumption of chicken by rich women and rural poor women with access to rice fields (p < .05). Rice was a strongly inferior good and remained an important supplier of energy, protein, and carbohydrate. Nuts and pulses were important suppliers of calcium and iron, and vegetables were an important supplier of vitamin A. Rich women increased their intake of nuts and pulses, vegetables, fats and oils, and sugar when their intake of rice increased (p < .05). The food patterns were based on rice, nuts and pulses, and vegetables, i.e., plant food. All but the rich women decreased their intake of nutritious foods such as meat, chicken, and fruits. The intake of nuts and pulses and of vegetables increased, whereas the intake of cooking oil and sugar remained constant.

Direct Method for Determination of Al, Cd, Cu, and Pb in Beers In Situ Digested by GF AAS Using Permanent Modifiers

The object of the present study was to development of safe, reliable fast, and efficient methodologies for the direct determination of Al, Pb, Cu, and Cd in non-digested beer samples of widely consumed brand name beers sold in Brazil, using graphite furnace absorption spectrometry (GF AAS). Pyrolysis and atomization temperature curves of selected chemical modifiers (iridium, rhodium, ruthenium, zirconium, and non-modifier use) were used to stabilize each metal and sensitivity in a beer sample was diluted to 1:1 with 0.2 % v/v nitric acid after degasification. The best modifier for aluminum was permanent zirconium, with a characteristic mass of 4.2 pg (recommended is 10 pg), demonstrating a symmetrical peak with a corrected background using a deuterium arc lamp. For cadmium and copper, the best modifier was permanent ruthenium with characteristic masses of 0.3 and 7 pg (recommended are 0.35 and 4 pg, respectively, for Cd and Cu), respectively. The best condition for lead was using a non-modifier, with a characteristic mass of 6.9 pg (recommended is 10 pg). The limits of detection and mean recoveries, done over three consecutive days for aluminum, copper, lead, and cadmium, were 1.9, 2.9, 0.8, and 0.6 pg and 105, 104, 101, and 102 %, respectively. From the observed results, we may conclude that some metals, such as Al, Cd, Cu, and Pb, can be determined easily with graphite furnace atomic absorption spectrometry without sample digestion using a dilute nitric acid solution.

ET AAS evaluation of the stability and pH-sensitivity of, pH-sensitive stealth liposomes containing cisplatin in mouse plasma

In this work, stability and the pH-sensitivity of pH-sensitive stealth liposomes containing cisplatin exposed to plasma medium and their subsequent responses to pH modifications were evaluated. A method to determine platin in mouse plasma by electrothermal atomic absorption spectroscopy (ET AAS) was developed and validated. At first, a comparative study of sample preparation treatments with basic, acidic, and acidic added with Triton X-100 as a modifier was done. The best treatment was obtained with HCl 3% (v/v). The ET AAS method with acid treatment presented linearity at a range of 10-160 ng Pt/mL. The limits of detection (LOD) was 3.1 ng/mL Pt for acid treatment, while the limit quantification (LOQ) was 10 ng/mL Pt. The acid treatment presented good repeatability (VC<15.0%) and recovery close to 100%. This treatment was chosen for subsequent studies due to its best value of repeatability, recovery, LOD and lowest cost. pH-sensitive stealth liposomes, containing cisplatin, demonstrated low stability and poor response to pH variation after plasma incubation. These findings suggest that further studies are needed to improve liposome formulation i.e., to reduce its size.

Plasma zinc and hair zinc levels, anthropometric status and food intake of children in a rural area of Brazil

OBJECTIVE: The objective of this study was to investigate the levels of plasma zinc, hair zinc, growth and food consumption in children aged 6 to 24 months in a rural area of Diamantina (MG), Brazil. METHODS: Plasma and hair zinc concentrations were analyzed using flame atomic absorption spectrometry and neutron activation analysis, respectively. Weight-for-age, weight-for-height and height-for-age, expressed as Z-scores, were measured according to the World Health Organization reference curves. Dietary zinc intake was determined by a 3-day dietary recall filled out by the mother or guardian. RESULTS: Zinc deficiency was found in 11.2% and 16.8% of the children according to plasma zinc e hair zinc levels, respectively. Mean plasma zinc and hair zinc for children <11 (49) and >11 (127) months of age were 15.4 (SD=4.2) µmol L-1 and 139.5 (SD=72.1) µg g-1 and 16.0 (SD=4.5) µmol L-1 and 134.3 (SD=110.3) µg g-1, respectively. Anthropometric measurements showed that 8.0%, 6.8% and 3.4% of the children were underweight, stunted and wasted, respectively. The mean dietary intake of zinc was 3.2 (SD=2.3) mg/day. One-third of the children did not eat enough foods that contain zinc. There were no correlations among plasma zinc level, hair zinc level, anthropometric parameters and zinc intake. CONCLUION: The results demonstrate that zinc deficiency is a problem in the studied population, not just in malnourished children. Nutritional care should be provided for this population in order to improve their consumption of high-zinc foods and monitor zinc deficiency.

The profile of professionals in health and education fields at work in their communities

Social roles mold attitudes of actors who play the part in the community, and affect behavioral and moral attitudes and social conscience. There is a diversity of behaviors that demonstrates the extension to which individuals are in constant participation in the community life. A group profile of professional's health and education may supply information on the disciplinary approach in Community Health. Objective: to examine the profile of professionals at work in the Health and Education fields. Subjects participated in answering questions concerning professional work, leisure/religious activities, feeding/sleep habits, prevention and contraceptive methods, medical and/or psychological treatment and medicine/herbal use. Characteristics of the professional group regarding life style and the paradox of the practice of safe sex behavior were recorded. There exists the possibility to improve the quality of life for people in communities by reducing the sources of stress and tension by promoting physical and mental health. Methods should be investigated to allow for the promotion of a quality of life in a small fraction of the population engaged in health and education work in their own communities.