Elaine Silva Miranda

Uncomplicated malaria among pregnant women in the Brazilian Amazon: local barriers to prompt and effective case management.

Malaria in pregnancy is associated with increased risks of maternal anemia, spontaneous abortion, low birth weight, premature delivery and other adverse effects on health. In Brazil, disease transmission is highly concentrated in the multi-state region that constitutes the Brazilian Amazon (more than 99% of all cases). This study, conducted between the first bimesters of 2007 and 2008, aims to identify the local barriers to prompt and effective case management of malaria in pregnancy and was carried out in health facilities located in three endemic municipalities of the Brazilian Amazon (Manaus, Presidente Figueiredo and Porto Velho). The study design combined both qualitative and quantitative descriptive methods. The qualitative design involved semi-structured interviews with health personnel who routinely deal with malaria care. The quantitative design involved a review of medical records of pregnant women in the visited health facilities. Additionally, data were abstracted from SIVEP-Malaria Epidemiological Surveillance Information System (Brasil, 2007) and Primary Care Information System (SIAB) databases. Flaws were detected in diagnosis (only 6.8% of women tested for malaria) and treatment (for Plasmodium falciparum infections, only 44.8% of patients received recommended first-line therapy; 10.2% of prescription presented treatments were not found in national guideline and 7.3% of the prescriptions for Plasmodium vivax and 17.9% of the prescriptions for P. falciparum were not sanctioned by the official guidelines). Training (only 37.3% had had some training), knowledge and counseling were also sub-optimal. These results indicated the need to improve the health-worker performance through training. Close supervision and feedback on the health-worker performance are also needed. These findings also highlighted the need to put into practice a series of government recommendations that encourage close collaboration between the National Malaria Control Program and Primary Health Care actions in order to achieve safer pregnancies.

Pharmaceutical services for endemic situations in the Brazilian Amazon: organization of services and prescribing practices for Plasmodium vivax and Plasmodium falciparum non-complicated malaria in high-risk municipalities

BackgroundIn spite of the fact that pharmaceutical services are an essential component of all malaria programmes, quality of these services has been little explored in the literature. This study presents the first results of the application of an evaluation model of pharmaceutical services in high-risk municipalities of the Amazon region, focusing on indicators regarding organization of services and prescribing according to national guidelines.MethodsA theoretical framework of pharmaceutical services for non-complicated malaria was built based on the Rapid Evaluation Method (WHO). The framework included organization of services and prescribing, among other activities. The study was carried out in 15 primary health facilities in six high-risk municipalities of the Brazilian Amazon. Malaria individuals ≥ 15 years old were approached and data was collected using specific instruments. Data was checked by independent reviewers and fed to a data bank through double-entry. Descriptive variables were analyzed.ResultsA copy of the official treatment guideline was found in 80% of the facilities; 67% presented an environment for receiving and prescribing patients. Re-supply of stocks followed a different timeline; no facilities adhered to forecasting methods for stock management. No shortages or expired anti-malarials were observed, but overstock was a common finding. On 86.7% of facilities, the average of good storage practices was 48%. Time between diagnosis and treatment was zero days. Of 601 patients interviewed, 453 were diagnosed for Plasmodium vivax; of these, 99.3% received indications for the first-line scheme. Different therapeutic schemes were given to Plasmodium falciparum patients. Twenty-eight (4.6%) out of 601 were prescribed regimens not listed in the national guideline. Only 5.7% individuals received a prescription or a written instruction of any kind.ConclusionsThe results show that while diagnostic procedure is well established and functioning in the Brazilian malaria programme, prescribing is still an activity that is actually not performed. The absence of physicians and poor integration between malaria services and primary health services make for the lack of a prescription or written instruction for malaria patients throughout the Brazilian Amazon. This fact may lead to a great number of problems in rational use and in adherence to medication.

Preparação da assistência farmacêutica para desastres: um estudo em cinco municípios brasileiros

A number of Brazilian municipalities have been affected by disasters in recent years. Municipal managers need to invest in preparedness to mitigate the impact of events and to restrict damages. Disaster preparedness should be conducted on various fronts, including the health sector, of which pharmaceutical services (PS) are a part. The scope of this paper is to describe and analyze PS preparedness in municipalities recently stricken by disasters. For this purpose, an investigation of a cross-sectional design involving various sources (official documents, newspaper articles, public databases and interviews with key PS informants) was conducted in five municipalities in two different regions. Analysis was based on an instrument with a logical model and indicators. Despite the fact that these municipalities are historically disaster-prone, very few measures of PS preparedness were encountered, which is clear evidence that management of PS has not been achieved. It is to be hoped that this presentation of the experiences of these municipalities might foster PS preparedness in other Brazilian municipalities.

Health education policy: evaluative study of Pró-Saúde and PET-Saúde

Objetivo: Avaliar a potencia das propostas Pro-Saude e PET-Saude para propiciar uma formacao em rede, interdisciplinar e integral, a partir da micropolitica do trabalho vivo, considerando a complexidade do processo de articulacao ensino/servico desenvolvida a partir de grupos tutorais. As propostas que serao investigadas sao as vinculadas a Universidade Federal Fluminense, Universidade Federal do Rio de Janeiro e Universidade Estadual de Campinas. Metodo: Pesquisa avaliativa, cujos dados serao coletados por: levantamento documental, observacao simples, entrevista semiestruturada, grupo focal com atores de instituicoes de ensino, gestores, alunos, usuarios e profissionais das equipes de saude e autoconfrontacao cruzada, no periodo de dezembro de 2013 a agosto de 2014. Tratar-se-ao os dados por meio de analise do discurso. Resultados: Instrumento para a avaliacao das praticas pedagogicas em servico com enfase na integralidade da atencao considerando o contexto local/regional que a pesquisa for realizada.

Magistral drugs in hospitalized newborns and children.

Abstract Objective: Study the use of magistral oral solutions and suspensions in infants and children at a university hospital. Methods: This is a descriptive study based on the analysis of the assessed hospitals magistral drug request forms regarding the patients in the neonatal ICU, Obstetrics, Pediatrics and Pediatric Emergency from January 2012 to December 2013. The frequency of drug requests and dispensation was evaluated and the consumption of each active ingredient of the preparations was expressed as number of “infant defined daily dose” (iDDD) and of iDDD/100 bed-days. Results: A total of 657 forms were analyzed - a monthly average of 27 pediatric preparations. The neonatal ICU accounted for 69.6% of these requests. Twenty-one drug items were used, of which the most common were folinic acid (88 requests), sulfadiazine (85) and captopril (73). The consumption of the active principle in these preparations varied in number of iDDD, from 7.5 (hydralazine) to 16,520.0 (folic acid), and in number of iDDD/100 bed-days in the neonatal ICU, from 0.1 (zinc sulfate) to 146.1 (folic acid). Conclusions: The constant consumption of magistral oral solutions and suspensions by newborns and children of the assessed hospital indicates the need for such preparations as a pediatric therapeutic alternative in this hospital.