Carlos Antonio de Souza Teles Santos

Effect of a conditional cash transfer programme on childhood mortality: a nationwide analysis of Brazilian municipalities

BACKGROUND In the past 15 years, Brazil has undergone notable social and public health changes, including a large reduction in child mortality. The Bolsa Familia Programme (BFP) is a widespread conditional cash transfer programme, launched in 2003, which transfers cash to poor households (maximum income US

Obesity and vitamin D deficiency: a systematic review and meta‐analysis

70 per person a month) when they comply with conditions related to health and education. Transfers range from

Doença periodontal materna como fator associado ao baixo peso ao nascer

18 to

Estimating adjusted prevalence ratio in clustered cross-sectional epidemiological data

175 per month, depending on the income and composition of the family. We aimed to assess the effect of the BFP on deaths of children younger than 5 years (under-5), overall and resulting from specific causes associated with poverty: malnutrition, diarrhoea, and lower respiratory infections. METHODS The study had a mixed ecological design. It covered the period from 2004-09 and included 2853 (of 5565) municipalities with death and livebirth statistics of adequate quality. We used government sources to calculate all-cause under-5 mortality rates and under-5 mortality rates for selected causes. BFP coverage was classified as low (0·0-17·1%), intermediate (17·2-32·0%), high (>32·0%), or consolidated (>32·0% and target population coverage ≥100% for at least 4 years). We did multivariable regression analyses of panel data with fixed-effects negative binomial models, adjusted for relevant social and economic covariates, and for the effect of the largest primary health-care scheme in the country (Family Health Programme). FINDINGS Under-5 mortality rate, overall and resulting from poverty-related causes, decreased as BFP coverage increased. The rate ratios (RR) for the effect of the BFP on overall under-5 mortality rate were 0·94 (95% CI 0·92-0·96) for intermediate coverage, 0·88 (0·85-0·91) for high coverage, and 0·83 (0·79-0·88) for consolidated coverage. The effect of consolidated BFP coverage was highest on under-5 mortality resulting from malnutrition (RR 0·35; 95% CI 0·24-0·50) and diarrhoea (0·47; 0·37-0·61). INTERPRETATION A conditional cash transfer programme can greatly contribute to a decrease in childhood mortality overall, and in particular for deaths attributable to poverty-related causes such as malnutrition and diarrhoea, in a large middle-income country such as Brazil. FUNDING National Institutes of Science and Technology Programme, Ministry of Science and Technology, and Council for Scientific and Technological Development Programme (CNPq), Brazil.

Lower Hookworm Incidence, Prevalence, and Intensity of Infection in Children with a Bacillus Calmette-Guerin Vaccination Scar

Over the past decade, there have been an increasing number of studies on the association between vitamin D deficiency and anthropometric state. However, we did not identify any meta‐analyses of the relationship between obesity and vitamin D deficiency in different age groups. Thus, we evaluated the association between obesity and vitamin D deficiency. We searched for observational studies published up to April 2014 in PubMed/Medline, Web of Science and Scopus databases. We performed a meta‐analysis in accordance with the random‐effects model to obtain the summary measurement (prevalence ratio, PR). Among the 29,882 articles identified, 23 met the inclusion criteria. The prevalence of vitamin D deficiency was 35% higher in obese subjects compared to the eutrophic group (PR: 1.35; 95% CI: 1.21–1.50) and 24% higher than in the overweight group (PR: 1.24; 95% CI: 1.14–1.34). These results indicate that the prevalence of vitamin D deficiency was more elevated in obese subjects. The vitamin D deficiency was associated with obesity irrespective of age, latitude, cut‐offs to define vitamin D deficiency and the Human Development Index of the study location.

Childbirth and live newborns of adolescent and young adult mothers in the municipality of Feira de Santana, Bahia State, Brazil, 1998

OBJETIVO: Estudos recentes tem apresentado evidencias de que a doenca periodontal em gestantes pode ser um dos determinantes do baixo peso ao nascer. Realizou-se estudo para verificar a existencia de associacao entre doenca periodontal materna e baixo peso ao nascer. METODOS: Estudo do tipo caso-controle com 302 mulheres, sendo 102 maes de nascidos vivos de baixo peso (grupo caso) e 200 maes de nascidos vivos com peso normal (grupo controle). A existencia de associacao entre doenca periodontal e baixo peso ao nascer foi avaliada mediante modelo multivariado de regressao logistica, considerando outros fatores de risco para o baixo peso. RESULTADOS: Ambos os grupos de maes eram comparaveis no que se refere a idade, altura, peso pre-gestacional, tabagismo, alcoolismo, doencas previas, estado civil, situacao socioeconomica, numero de escovacoes e uso de fio dental, numero de refeicoes diarias, e visitas ao dentista. A doenca periodontal foi diagnosticada em 57,8% das maes do grupo caso e 39,0% do grupo controle. A analise de regressao logistica indicou associacao positiva entre doenca periodontal e baixo peso ao nascer (ORbruto=2,15; IC 95%: 1,32-3,48), especialmente entre as maes com escolaridade menor ou igual a quatro anos (ORajustada=3,98; IC 95%: 1,58-10,10). CONCLUSOES: A doenca periodontal e um possivel fator de risco para o baixo peso ao nascer.OBJECTIVE Recent studies have presented evidence that periodontal disease in pregnant women may be a determining factor for low birth weight. The present investigation was carried out to verify whether or not there is an association between maternal periodontal disease and low birth weight. METHODS This was a case-control study on 302 women, of whom 102 were the mothers of live newborns of low weight (case group) and 200 were the mothers of live newborns of normal birth weight (control group). The existence of an association between periodontal disease and low birth weight was evaluated by means of a multivariate logistic regression model that considered other risk factors for low weight. RESULTS The two groups were comparable with regard to age, height, pre-gestational weight, smoking, alcohol use, previous diseases, marital status, socioeconomic status, frequency of tooth-brushing and use of dental floss, number of meals per day and visits to the dentist. Periodontal disease was diagnosed in 57.8% of the mothers in the case group and 39.0% in the control group. Logistic regression analysis indicated a positive association between periodontal disease and low birth weight (unadjusted OR=2.15; 95% CI: 1.32-3.48), especially among the mothers with schooling of less than or equal to four years (ORadjusted=3.98; 95% CI: 1.58-10.10). CONCLUSIONS Periodontal disease is a possible risk factor for low birth weight.

Effectiveness of rotavirus vaccine against hospitalized rotavirus diarrhea: A case-control study

BackgroundMany epidemiologic studies report the odds ratio as a measure of association for cross-sectional studies with common outcomes. In such cases, the prevalence ratios may not be inferred from the estimated odds ratios. This paper overviews the most commonly used procedures to obtain adjusted prevalence ratios and extends the discussion to the analysis of clustered cross-sectional studies.MethodsPrevalence ratios(PR) were estimated using logistic models with random effects. Their 95% confidence intervals were obtained using delta method and clustered bootstrap. The performance of these approaches was evaluated through simulation studies. Using data from two studies with health-related outcomes in children, we discuss the interpretation of the measures of association and their implications.ResultsThe results from data analysis highlighted major differences between estimated OR and PR. Results from simulation studies indicate an improved performance of delta method compared to bootstrap when there are small number of clusters.ConclusionWe recommend the use of logistic model with random effects for analysis of clustered data. The choice of method to estimate confidence intervals for PR (delta or bootstrap method) should be based on study design.

Gravidez na adolescência e co-responsabilidade paterna: trajetória sociodemográfica e atitudes com a gestação e a criança

Bacillus Calmette-Guérin (BCG), the most common vaccine worldwide, has broad effects on the immune system. Hookworm infections are a major source of morbidity. In response to a preliminary report of BCG vaccination protection against nematodes in human immunodeficiency virus-infected adults, data from an ongoing prospective study were analyzed to determine the intensity (eggs per gram of stool), prevalence, and incidence of different helminths in children with and without a BCG vaccination scar. Adjusted prevalence and incidence ratios were estimated by using logistic regression. Children with a BCG vaccination scar were found to have statistically significantly lower hookworm prevalence (41%), incidence (37%), and mean egg counts (39%), after controlling for age, sex, and socioeconomic factors. There was no BCG association with incidence, prevalence, or intensity of infection with Schistosoma mansoni, Ascaris lumbricoides, or Trichuris trichiura. Such protection would have implications for public health and for research on mechanisms behind human immunological responses to hookworm.

Structural equation modeling in epidemiology

Data from the Brazilian Ministry of Health and the literature indicate that adolescents may be overrepresented in the prevalence of maternal morbidity and mortality and neonatal complications. This study focused on childbirth and live newborns among adolescent and young adult mothers in the municipality of Feira de Santana, Bahia, identifying risk factors for morbidity and mortality. A cross-sectional cohort study was conducted based on data from the Information System on Live Births (SINASC) in the municipality in 1998, totaling 5,279 live births among adolescent (10 to 19 years) and young adult mothers (20 to 24 years). Variables were age, schooling, prenatal care, gestational care, form of delivery, and birthweight. The authors measured the association between maternal age and the childs birthweight, while controlling potential confounders. Some 21.6% of live births were to adolescent mothers, 51.2% of whom had not finished primary school; there was an association between the 10 to 16-year age bracket and incomplete primary schooling, lack of prenatal care, and low and insufficient birthweight as compared to the other age brackets; there was also a high rate of underrecording in the SINASC. The results suggest the need for specific measures focusing on the reproductive health of adolescents in the municipality.

Adolescents' knowledge about adolescence, puberty and sexuality

Rotavirus is one of the leading cause of hospitalization and outpatients visits among children under five years. This study evaluated overall and genotype-specific vaccine effectiveness of oral monovalent rotavirus vaccine (G1P[8] strain) in preventing hospital admission of Brazilian children with rotavirus acute diarrhea. A hospital based case-control study was conducted in five Regions of Brazil using the National Rotavirus Acute Diarrhea Surveillance System from July 2008 to August 2011. A total of 215 cases (aged 4-24 months) admitted with confirmed rotavirus diarrhea were recruited and 1961 controls hospitalized without diarrhea were frequency matched by sex and age group to cases. Two-dose adjusted vaccine effectiveness (adjusted by year of birth and the frequency matching variables) was 76% (95%CI: 58-86) lasting for two years. Effectiveness controlled by the available potential confounders was 72% (95%CI: 44-85), suggesting no appreciable confounding by those factors for which adjustment was made. In a half of the cases the rotavirus genotype was G2P[4] and in 15% G1P[8]. Genotype-specific VE (two doses) was 89% (95%CI: 78-95), for G1P[8] and 76% (95%CI: 64-84) for G2P[4]. For all G1, it was 74% (95%CI: 35-90), for all G2, 76% (95%CI: 63-84), and for all non G1/G2 genotypes, 63% (95%CI: -27-99). Effectiveness for one dose was 62% (95%CI: 39-97). Effectiveness of two-dose monovalent rotavirus vaccine in preventing hospital admission with rotavirus diarrhea was high, lasted for two years and it was similar against both G1P[8] and G2P[4]. Based on the findings of the study we recommend the continued use of rotavirus in the Brazilian National Immunization Program and the monitoring of the early emergence of unusual and novel rotavirus genotypes.