Christiane Borges do Nascimento Chofakian

Conhecimento sobre anticoncepção de emergência entre adolescentes do Ensino Médio de escolas públicas e privadas

O objetivo do estudo foi analisar o nivel de conhecimento sobre anticoncepcao de emergencia entre adolescentes do Ensino Medio de escolas publicas e privadas. Estudo transversal com a participacao de 705 estudantes de 15 a 19 anos, matriculados no Ensino Medio de escolas publicas e privadas de um municipio do Estado de Sao Paulo, Brasil. Utilizou-se amostragem probabilistica estratificada por tipo de escola e sistematica por turma. Cerca de 24,9% dos adolescentes das escolas privadas e 32% das escolas publicas haviam iniciado a vida sexual e usado a anticoncepcao de emergencia. A media de escore de conhecimento foi de 3,87 (DP = 2,12) nas escolas publicas e 5,14 (DP = 2,00) nas escolas privadas. Analise de regressao linear multipla mostrou que adolescentes de escolas privadas, do sexo feminino, com mais idade, que ja tinham iniciado a vida sexual, usado a anticoncepcao de emergencia e conheciam alguem que ja usou o metodo, foram as que alcancaram o maior escore de conhecimento. Conclui-se que poucos adolescentes estao corretamente informados sobre o metodo e muitos tem ideias equivocadas.This study aimed to analyze the level of knowledge concerning emergency contraception among adolescents in public and private high schools. This was a cross-sectional study with 705 students 15 to 19 years of age enrolled in public and private high schools in a municipality in São Paulo State, Brazil. The authors used stratified probabilistic sampling by type of school and systematic sampling by class. Sexual initiation and use of emergency contraception were reported by 24.9% of private school students and 32% of public school students. The mean score on knowledge was 3.87 (SD = 2.12) in public schools and 5.14 (SD = 2.00) in private schools. Multiple linear regression analysis showed that higher scores on knowledge concerning emergency contraception were associated with: enrollment in private schools, female gender, older adolescents, sexual initiation, previous use of emergency contraception, and knowing someone who had used the method. The study concludes that few adolescents are properly informed about the method and that many harbor persistent misconceptions.

Women’s reproductive health knowledge, attitudes and practices in relation to the Zika virus outbreak in northeast Brazil

Objectives To assess knowledge, pregnancy attitudes and contraceptive practices in relation to the Zika virus outbreak in Brazil. Methods We interviewed 526 women 18 to 49 years old in primary health services in a Northeastern capital of Brazil, in 2016. They provided information about their knowledge of Zika transmission and health consequences, their receipt of counseling related to sexual and perinatal transmission of Zika, their pregnancy intentions and reassessment of contraceptive options in the context of the Zika virus outbreak. Results Awareness about Zika congenital syndrome was high, but knowledge about sexual transmission was low. Few women had changed pregnancy intentions or contraceptive practices in response to Zika. Pregnant women were more likely to access counseling about family planning, condom use and pregnancy postponement due to Zika virus than non-pregnant women, which may suggest that health system responses followed pregnancy occurrence. Conclusions We observed missed opportunities for prevention of perinatal transmission of Zika virus through behavioral change, including effective contraception to prevent pregnancy and condoms to prevent perinatal transmission, as a complement to vector control.

ERICA: sexual initiation and contraception in Brazilian adolescents

ABSTRACT OBJECTIVE To estimate the prevalence of sexual initiation and contraceptive use at the last sexual intercourse of Brazilian adolescents, according to sociodemographic features. METHODS The data were obtained from the Study of Cardiovascular Risks in Adolescents (ERICA), a national school-based cross-sectional study. We included 74,589 adolescents from 32 geographic strata (27 capitals and five sets of municipalities with more than 100,000 inhabitants of each of the five macro-regions of the Country). Information on sexual initiation and contraceptive use at the last sexual intercourse (male condom and oral contraceptive pill) has been used. We have estimated prevalence and confidence intervals (95%CI) considering sample weights according to sex, age, type of school, residence status, macro-region and capitals. RESULTS We observed that 28.1% (95%CI 27.0-29.2) of the adolescents had already initiated sexual life, with higher prevalence among those aged 17 years (56.4%, 95%CI 53.9-58.9), males (33.5%, 95%CI 31.8-35.2), studying at public schools (29.9%, 95%CI 28.5-31.4), and from the Northern region (33.9%, 95%CI 32.3-35.4), mainly from Macapa, Manaus, and Rio Branco. Among those who had started their sexual life, 82.3% (95%CI 81.1-83.4) reported the use of contraceptive methods at the last intercourse, and the prevalence of use was higher among adolescents aged 17 years (85.3%, 95%CI 82.7-87.6), females (85.2%, 95%CI 83.8-86.5) and those living in the Southern region (85.9%, 95%CI 82.9-88.5). Male condom was used by 68.8% (95%CI 66.9-70.7), with no difference by type of school or macro-regions; the contraceptive pill was used by 13.4% (CI95% 12.2-14.6), and more frequently used among women (24.7%, 95%CI 22.5-27,0) and 17-year-old adolescents (20.8%, 95%CI 18.2-23.6) from urban settings(13.7%, 95%CI 12.5-14.9) and from the Southern region (22.6%, 95%CI 19.0-26.8), and less often in the Northern region. CONCLUSIONS ERICA’s data analysis on sexuality and contraception shows heterogeneities in the prevalence of sexual initiation and use of contraceptive methods among Brazilian adolescents, depending on their age, where they live, and the type of school they study at. Younger adolescents and those living in the Northern region seem to be more vulnerable to the consequences of unprotected sexual intercourses.

Determinants of emergency contraception non-use among women in unplanned or ambivalent pregnancies

Objective To analyze the determinants of emergency contraception non-use among women in unplanned and ambivalent pregnancies. Method Cross-sectional study with a probabilistic sample of 366 pregnant women from 12 primary health care units in the city of São Paulo, Brazil. A multinomial logistic regression was performed, comparing three groups: women who used emergency contraception to prevent ongoing pregnancies (reference); women who made no use of emergency contraception, but used other contraceptive methods; and women who made no use of any contraceptive methods at all. Results Cohabitation with a partner was the common determinant of emergency contraception non-use. No pregnancy risk awareness, ambivalent pregnancies and no previous use of emergency contraception also contributed to emergency contraception non-use. Conclusion Apart from what is pointed out in the literature, knowledge of emergency contraception and the fertile period were not associated to its use.Objective To analyze the determinants of emergency contraception non-use among women in unplanned and ambivalent pregnancies. Method Cross-sectional study with a probabilistic sample of 366 pregnant women from 12 primary health care units in the city of Sao Paulo, Brazil. A multinomial logistic regression was performed, comparing three groups: women who used emergency contraception to prevent ongoing pregnancies (reference); women who made no use of emergency contraception, but used other contraceptive methods; and women who made no use of any contraceptive methods at all. Results Cohabitation with a partner was the common determinant of emergency contraception non-use. No pregnancy risk awareness, ambivalent pregnancies and no previous use of emergency contraception also contributed to emergency contraception non-use. Conclusion Apart from what is pointed out in the literature, knowledge of emergency contraception and the fertile period were not associated to its use.

Fertility rates among very young adolescent women: temporal and spatial trends in Brazil

BackgroundWe assessed whether the reported decrease in fertility rates among 15 to 19 years old Brazilian adolescents has met with a parallel decrease in very young adolescent (10 to 14 years old) fertility rates. So we explored temporal trends for fertility rates among very young adolescents between 2000 and 2012 for Brazil as a whole, its regions and states; and also analyzed the spatial distribution of fertility rates among Brazilian municipalities in the years 2000 and 2012.MethodsWe used data from the Information System on Live Births to calculate the rates. To examine the temporal trends, we used linear regression for time series with Prais-Winsten estimation, including the annual percentage change, for the country, regions, and states. To analyze the spatial distribution among Brazilian municipalities, we calculated the Global Moran Index and created a local Moran significance and cluster map through Local Indicators of Spatial Association (LISA). We also elaborated a thematic map with the rates using empirical Bayesian estimation.ResultsBrazilian very young adolescent fertility rates remained high and stable throughout the 2000 to 2012 period, and significantly decreased in three out of 26 states, and in the federal district. On the other hand, an increase was observed in two Northern and Northeastern states. The rates were spatially dependent in Brazilian municipalities (Moran Index = 0.22 in 2012; p = 0.05). The maps indicated a heterogeneous distribution of the rates, with high-rate clusters predominant in the North and low-rate clusters predominant in the South, Southeast, and Midwest.ConclusionsOur findings indicate that Brazilian very young adolescent fertility rates have not decreased in parallel with adolescent fertility rates as they remain high and did not decrease from 2000 and 2012, even though a few states presented a decrease. Thus, these phenomena probably have distinct underlying causes that warrant further elucidation. Progress in this field is crucial for the development of specific policies and programs focused on very young adolescents.

Post-abortion contraception: care and practices

Objective to analyze assistance regarding contraception methods received by women during hospitalization due to abortion, and contraceptive practices the month after this episode. Methods a longitudinal study of women hospitalized due to abortion in a public hospital in the city of São Paulo. Face-to-face interviews (n=170) followed by telephone interviews in the subsequent month (n=147) were conducted between May and December of 2011. Results a small number of women reported they received guidance on, and prescription for, contraceptive methods at hospital discharge. A trend of statistical significance was identified for prescription of contraceptive methods at discharge and its use in the following month, when adjusted for age. Most women reported sexual intercourse (69.4%) with the use of contraceptive method (82.4%), but no health professional guidance (63.1%). Conclusion despite the fact that post-abortion contraception assistance was lower than the recommended guidelines by public health policies, women demonstrated willingness to use contraceptive methods.OBJETIVO: analisar a atencao em anticoncepcao recebida por mulheres durante a hospitalizacao por abortamento e suas praticas contraceptivas, no mes subsequente a esse episodio. METODO: estudo longitudinal com mulheres hospitalizadas por abortamento, em uma maternidade publica da cidade de Sao Paulo. Foram feitas entrevistas face a face (n=170) e, apos um mes, por contato telefonico (n=147) entre maio e dezembro de 2011. RESULTADOS: as orientacoes em anticoncepcao e a alta hospitalar com metodo anticonceptivo prescrito foram referidas por proporcao reduzida de mulheres. Houve tendencia de significância estatistica para a prescricao de metodo anticonceptivo, ajustado pela idade, na alta hospitalar e o seu uso no mes subsequente. A maioria das mulheres teve relacoes sexuais (69,4%) com uso de metodo anticoncepcional (82,4%), mas sem orientacao de profissional de saude (63,1%). CONCLUSAO: apesar da atencao em anticoncepcao pos-abortamento estar aquem das diretrizes estabelecidas pelas politicas publicas, as mulheres demonstraram disponibilidade para usar metodos anticonceptivos.

Preconception health behaviors associated with pregnancy planning status among Brazilian women

OBJECTIVE The objective of this study is to assess preconception health behaviors among Brazilian women, and analyze the effect of pregnancy planning status in carrying out preconception measures. METHOD This is a cross-sectional quantitative study conducted with 807 women, of whom 649 had a planned or ambivalent pregnancy. Preconception health behaviors were assessed by the Brazilian version of the London Measure of Unplanned Pregnancy. RESULTS Preconception health behaviors were performed by only 15.9% of women. Among those who planned their pregnancy, less than half completed a health measure (47.0%); the most common was seeking medical assistance and improving the diet. Multiple logistic regression analysis showed a strong association between the preconception health behaviors and a planned pregnancy (adjusted OR = 16.77; 95% CI: 9.47-29.81). Age over 30 years, paid work, and the time interval between menarche and first sexual intercourse were also associated with completing preconception measures. CONCLUSION The low frequency of preconception health measures, even among women who planned their pregnancy, indicates the urgency of including preconception care on the agenda of public health policies in Brazil. OBJETIVO Mensurar a realização do preparo pré-concepcional, descrever as medidas adotadas como preparo pré-concepcional e analisar o efeito do planejamento da gravidez na realização do preparo pré-concepcional. MÉTODO Estudo quantitativo, do tipo transversal, conduzido com 807 mulheres, das quais 649 tinham gravidez planejada ou ambivalente. O preparo pré-concepcional foi mensurado a partir do London Measure of Unplanned Pregnancy , versão Brasil. RESULTADOS O preparo pré-concepcional foi realizado por apenas 15,9% das mulheres. Dentre as que planejaram a gravidez, menos da metade realizou algum preparo (47,0%), sendo os mais frequentes ter procurado assistência médica e mudanças na alimentação. Análise de regressão logística múltipla mostrou forte associação entre a realização do preparo pré-concepcional e o planejamento da gravidez (ORajustado=16,77; IC95% 9,47-29,81). A idade acima de 30 anos, o trabalho remunerado e o intervalo de tempo entre a menarca e a primeira relação sexual também estiveram associados à realização do preparo pré-concepcional. CONCLUSÃO A baixa frequência de realização de preparo pré-concepcional, mesmo entre mulheres com gravidez planejada, indica a urgência de se incluir o cuidado pré-concepcional na agenda de políticas públicas de saúde.Medir la realizacion de la preparacion pre concepcional, describir las medidas adoptadas como preparacion pre concepcional y analizar el efecto de la planificacion del embarazo en la preparacion pre concepcional. METODO Estudio cuantitativo, del tipo transversal, conducido con 807 mujeres, de las cuales 649 tenian embarazo planificado o ambivalente. La preparacion pre concepcional fue medida mediante el London Measure of Unplanned Pregnancy , version Brasil. RESULTADOS La preparacion pre concepcional fue realizada por solo el 15,9% de las mujeres. Entre las que planificaron el embarazo, menos de la mitad realizo alguna preparacion (47,0%), siendo las mas frecuentes haber buscado asistencia medica y cambios en la alimentacion. El analisis de regresion logistica multiple mostro fuerte asociacion entre la realizacion de la preparacion pre concepcional y la planificacion del embarazo (ORajustado=16,77; IC95% 9,47-29,81). La edad superior a 30 anos, el trabajo remunerado y el intervalo de tiempo entre la menarca y la primera relacion sexual tambien estuvieron asociados con la realizacion de la preparacion pre concepcional. CONCLUSION La baja frecuencia de realizacion de preparacion pre concepcional, aun entre mujeres con embarazo planificado, senala la urgencia de incluirse el cuidado pre concepcional en la agenda de politicas publicas de salud.

Contraceptive patterns after use of emergency contraception among female undergraduate students in Brazil

Abstract Objective: The aim of our study was to describe contraceptive patterns 30 days after use of emergency contraception (EC) among female undergraduate students in São Paulo, Brazil. Methods: This study was part of a larger project conducted in 2015 among 1679 female students aged 18–24 enrolled at the University of São Paulo. Analysis was restricted to the 916 students who reported lifetime use of EC. Logistic regression models were used to examine factors related to the use of contraception within the 30 day period following the last use of EC, changes in contraceptive behaviour before and after EC use, and gaps in contraceptive use within 30 days after EC use. Results: Most women (75.4%) used contraception after accessing EC; 92.9% who used contraception prior to EC exposure resumed use of contraception afterwards, compared with 40.7% who did not use contraception prior to EC exposure. Only 6.3% of women switched to a less effective contraceptive method after EC use. Few women (7.5%) reported post-EC gaps in contraception. Conclusions: The results of this study suggest that EC may serve as a potential precursor to regular contraception among undergraduates in Brazil, with few women reporting contraceptive gaps after EC use. These patterns may contribute to reducing the risk of unintended pregnancy in this population.

Aleitamento materno: o que mudou após uma década?

Objective: to analyze the changes in prevalence, median duration and correlates of breastfeeding in a small city in Sao Paulo state, Brazil. Method: analysis of two cross-sectional studies, conducted at intervals of one decade, with 261 and 302 children younger than two years, respectively. We used Kaplan-Meier survival analysis for calculation of the median duration of breastfeeding, and Cox regression for correlates analysis, with significance level of 5%. Results: an increase of 33.4% in the prevalence of exclusive breastfeeding and 20.9% in breastfeeding was identified. Regarding the latter, the median duration increased from 7.2 to 12 months. In the most recent study, the median duration was lower in first-born children who used pacifiers, and it was not associated with breastfeeding incentive actions. Conclusions: advances in the prevalence and duration of breastfeeding were observed during the 10 year-period, however, pacifier use still remains associated to a shorter median duration of breastfeeding. Our findings contribute to highlighting the need for intensification of nursing actions in the promotion of breastfeeding, and discouragement regarding the use of pacifiers.ABSTRACT Objective: to analyze the changes in prevalence, median duration and correlates of breastfeeding in a small city in São Paulo state, Brazil. Method: analysis of two cross-sectional studies, conducted at intervals of one decade, with 261 and 302 children younger than two years, respectively. We used Kaplan-Meier survival analysis for calculation of the median duration of breastfeeding, and Cox regression for correlates analysis, with significance level of 5%. Results: an increase of 33.4% in the prevalence of exclusive breastfeeding and 20.9% in breastfeeding was identified. Regarding the latter, the median duration increased from 7.2 to 12 months. In the most recent study, the median duration was lower in first-born children who used pacifiers, and it was not associated with breastfeeding incentive actions. Conclusions: advances in the prevalence and duration of breastfeeding were observed during the 10 year-period, however, pacifier use still remains associated to a shorter median duration of breastfeeding. Our findings contribute to highlighting the need for intensification of nursing actions in the promotion of breastfeeding, and discouragement regarding the use of pacifiers.

Preparo pré-concepcional entre mulheres brasileiras e a relação com o planejamento da gravidez

OBJECTIVE The objective of this study is to assess preconception health behaviors among Brazilian women, and analyze the effect of pregnancy planning status in carrying out preconception measures. METHOD This is a cross-sectional quantitative study conducted with 807 women, of whom 649 had a planned or ambivalent pregnancy. Preconception health behaviors were assessed by the Brazilian version of the London Measure of Unplanned Pregnancy. RESULTS Preconception health behaviors were performed by only 15.9% of women. Among those who planned their pregnancy, less than half completed a health measure (47.0%); the most common was seeking medical assistance and improving the diet. Multiple logistic regression analysis showed a strong association between the preconception health behaviors and a planned pregnancy (adjusted OR = 16.77; 95% CI: 9.47-29.81). Age over 30 years, paid work, and the time interval between menarche and first sexual intercourse were also associated with completing preconception measures. CONCLUSION The low frequency of preconception health measures, even among women who planned their pregnancy, indicates the urgency of including preconception care on the agenda of public health policies in Brazil. OBJETIVO Mensurar a realização do preparo pré-concepcional, descrever as medidas adotadas como preparo pré-concepcional e analisar o efeito do planejamento da gravidez na realização do preparo pré-concepcional. MÉTODO Estudo quantitativo, do tipo transversal, conduzido com 807 mulheres, das quais 649 tinham gravidez planejada ou ambivalente. O preparo pré-concepcional foi mensurado a partir do London Measure of Unplanned Pregnancy , versão Brasil. RESULTADOS O preparo pré-concepcional foi realizado por apenas 15,9% das mulheres. Dentre as que planejaram a gravidez, menos da metade realizou algum preparo (47,0%), sendo os mais frequentes ter procurado assistência médica e mudanças na alimentação. Análise de regressão logística múltipla mostrou forte associação entre a realização do preparo pré-concepcional e o planejamento da gravidez (ORajustado=16,77; IC95% 9,47-29,81). A idade acima de 30 anos, o trabalho remunerado e o intervalo de tempo entre a menarca e a primeira relação sexual também estiveram associados à realização do preparo pré-concepcional. CONCLUSÃO A baixa frequência de realização de preparo pré-concepcional, mesmo entre mulheres com gravidez planejada, indica a urgência de se incluir o cuidado pré-concepcional na agenda de políticas públicas de saúde.Medir la realizacion de la preparacion pre concepcional, describir las medidas adoptadas como preparacion pre concepcional y analizar el efecto de la planificacion del embarazo en la preparacion pre concepcional. METODO Estudio cuantitativo, del tipo transversal, conducido con 807 mujeres, de las cuales 649 tenian embarazo planificado o ambivalente. La preparacion pre concepcional fue medida mediante el London Measure of Unplanned Pregnancy , version Brasil. RESULTADOS La preparacion pre concepcional fue realizada por solo el 15,9% de las mujeres. Entre las que planificaron el embarazo, menos de la mitad realizo alguna preparacion (47,0%), siendo las mas frecuentes haber buscado asistencia medica y cambios en la alimentacion. El analisis de regresion logistica multiple mostro fuerte asociacion entre la realizacion de la preparacion pre concepcional y la planificacion del embarazo (ORajustado=16,77; IC95% 9,47-29,81). La edad superior a 30 anos, el trabajo remunerado y el intervalo de tiempo entre la menarca y la primera relacion sexual tambien estuvieron asociados con la realizacion de la preparacion pre concepcional. CONCLUSION La baja frecuencia de realizacion de preparacion pre concepcional, aun entre mujeres con embarazo planificado, senala la urgencia de incluirse el cuidado pre concepcional en la agenda de politicas publicas de salud.