Elba Gomide Mochel

Factors associated with inadequacy of prenatal care utilization

OBJECTIVE To identify factors associated with inadequacy of prenatal care utilization in urban community. METHODS A cross-sectional study of a systematic sample stratified by maternity hospital, consisting of hospital births in the municipality of São Luís, Brazil, was carried out from March 1997 to February 1998. Socioeconomic and demographic factors, reproductive health, morbidity during pregnancy, and utilization of prenatal care services were studied. Mothers answered a standardized questionnaire before hospital discharge. The adequacy of prenatal care utilization was analyzed by means of two indexes: APNCU (Adequacy of Prenatal Care Utilization) and a new index based on the recommendations of the Brazilian Ministry of Health. RESULTS There were interviewed 2,831 women who delivered at 10 public and private maternity hospitals. The inadequacy of prenatal care utilization was 49.2% according to the APNCU index and 24.5% when determined by the Brazilian index. Prenatal care at public services, low maternal schooling, low income, having no partner, and absence of maternal diseases during pregnancy were associated with inadequacy of prenatal care use according to both indexes. High parity and maternal age of 35 years or more were also associated with inadequacy, whereas primiparity, morbidity, and young maternal age (<20 years) seemed to protect from inadequacy when the Brazilian index was used. CONCLUSIONS Prenatal care showed low coverage in the municipality of São Luís. The inadequacy of prenatal care utilization was associated with several factors linked to social inequality.

Características da gravidez na adolescência em São Luís, Maranhão

OBJECTIVE: To identify the main socioeconomic, demographic, anthropometric and behavioral characteristics, and pregnancy outcomes of adolescent pregnancy and to assess health services used by pregnant adolescents. METHODS: Data were collected from a cross-section of 2,429 deliveries by women residing in the municipality of Sao Luis, Brazil, of which 94% were hospital births. Women were categorized into six age groups. The two groups of teenagers (under 18 and 18-19 years) were compared to four groups of older women. Comparison was also made between the two teenage groups. The chi-square test was used to compare proportions and prevalence ratio was used as an effect measure. RESULTS: Of 2,429 women, 714 (29.4%) were adolescents. Their specific fertility coefficient was higher than in other regions of the country. Adolescents showed lower socioeconomic and reproductive conditions than older women and a higher proportion of inadequate prenatal care. The majority had no partner. They had the lowest percentages of caesarean section and smokers. CONCLUSIONS: Despite their equally unfavorable socioeconomic situation, 18-19 year-old adolescents had pregnancy outcomes comparable to the age group 25-29, whereas those under 18 had the highest proportions of low birth weight, preterm birth, and infant mortality rate. This suggests that biologic immaturity may be associated with adverse pregnancy outcomes.OBJETIVO: Identificar as principais caracteristicas socioeconomicas, demograficas, antropometricas e comportamentais, bem como os resultados perinatais da gravidez na adolescencia. Conhecer os tipos de servicos de saude utilizados pelas gestantes adolescentes. METODOS: A amostra de 2.429 partos de mulheres residentes em Sao Luis, MA, abrangeu 94% dos nascimentos hospitalares. As mulheres foram separadas em seis grupos de idade para melhor avaliacao do comportamento das variaveis entre os dois grupos de adolescentes (abaixo de 18 anos; 18 a 19 anos) e entre as adolescentes e as demais mulheres. O teste do qui-quadrado foi utilizado para a comparacao de proporcoes e a razao de prevalencias foi empregada como medida de efeito. RESULTADOS: Das 2.429 mulheres, 714 eram adolescentes (29,4%). Seu coeficiente especifico de fecundidade, 72,2 por mil, foi mais elevado que em outras regioes do Pais. As adolescentes apresentaram piores condicoes socioeconomicas e reprodutivas que as demais mulheres, maior proporcao de pre-natal inadequado (39,2%) e muitas nao tinham companheiro (34,5%). Por outro lado, tiveram menor proporcao de parto cesareo (23,0%) e de fumantes (3.5%). CONCLUSOES: Apesar da situacao socioeconomica igualmente desfavoravel, as adolescentes de 18 a 19 anos apresentaram resultados perinatais semelhantes as mulheres de 25 a 29 anos. Ja as menores de 18 anos tiveram maiores proporcoes de filhos com baixo peso ao nascer, prematuros e com maior risco de mortalidade infantil. Isto sugere que a imaturidade biologica possa estar associada a maiores taxas de prematuridade, baixo peso ao nascer e mortalidade infantil.OBJECTIVE To identify the main socioeconomic, demographic, anthropometric and behavioral characteristics, and pregnancy outcomes of adolescent pregnancy and to assess health services used by pregnant adolescents. METHODS Data were collected from a cross-section of 2,429 deliveries by women residing in the municipality of São Luís, Brazil, of which 94% were hospital births. Women were categorized into six age groups. The two groups of teenagers (under 18 and 18-19 years) were compared to four groups of older women. Comparison was also made between the two teenage groups. The chi-square test was used to compare proportions and prevalence ratio was used as an effect measure. RESULTS Of 2,429 women, 714 (29.4%) were adolescents. Their specific fertility coefficient was higher than in other regions of the country. Adolescents showed lower socioeconomic and reproductive conditions than older women and a higher proportion of inadequate prenatal care. The majority had no partner. They had the lowest percentages of caesarean section and smokers. CONCLUSIONS Despite their equally unfavorable socioeconomic situation, 18-19 year-old adolescents had pregnancy outcomes comparable to the age group 25-29, whereas those under 18 had the highest proportions of low birth weight, preterm birth, and infant mortality rate. This suggests that biologic immaturity may be associated with adverse pregnancy outcomes.

Perinatal health and mother-child health care in the municipality of São Luís, Maranhão State, Brazil

The purpose of this article was to evaluate socioeconomic and demographic indicators, reproductive health, use of prenatal, childbirth, and neonatal services, and anthropometric data for mothers and infants. The authors performed a cross-sectional analysis of a systematic sample of 2,831 hospital births in São Luís, Maranhão State, from March 1997 to February 1998 at ten public and private maternity hospitals. The sample was stratified proportionally according to the number of births in each maternity hospital. Mothers answered a standard questionnaire. Of the total, 97.9% were live births and 98% were singletons. Prenatal coverage was 89.5%, and prevalence of cesarean sections was 33.8%. A physician provided prenatal care in 75.7% of cases and performed 73.8% of the deliveries. The Unified Health System covered the costs of 76.4% of the prenatal visits and 89.7% of the deliveries. A pediatrician was present in the delivery room in 50.2% of cases. The low birth weight rate was 9.6% and the preterm birth rate 13.9%. Reasons for concern included a high percentage of adolescent mothers, single mothers (or without partners), the high cesarean rate, and the high percentage of births attended by unqualified personnel.

Aspects related to choice of type of delivery: a comparative study of two maternity hospitals in São Luís, State of Maranhão, Brazil

This study aimed to analyze aspects related to choice of type of delivery in two maternity hospitals, one public and the other private, in São Luís, Maranhão State, Brazil. This cross-sectional study compared 163 primiparous women in a public maternity hospital and 89 in a private hospital, with mean ages of 21.63 +/- 5.24 and 28.8 +/- 5.41 years, respectively. In the public hospital, 79.1% of the women reported preferring vaginal deliveries, while in the private hospital 67.4% of the women preferred cesareans (p < 0.0001). Cesareans were performed in 46% of the women in the public maternity hospital and 97.8% of those in the private hospital (p < 0.0001). Patient satisfaction was high for both modes of delivery, but the desire to repeat the same mode was reported more frequently by women with vaginal deliveries (71.6% vs. 41.3% in the public maternity hospital and 100% vs. 65.5% in the private). In the public maternity hospital, the cesarean subgroup included more white and higher-income women. The cesarean rate was thus high in both maternity hospitals and was significantly higher in the private hospital; the study also showed a preference for vaginal delivery in the public hospital and cesareans in the private.

Inadequate utilization of prenatal care in two Brazilian birth cohorts

Data for two birth cohorts from two Brazilian municipalities, Ribeirão Preto in 1994 and São Luís in 1997/1998, were used to identify and compare factors associated with inadequate utilization of prenatal care and to identify factors capable of explaining the differences observed between the two cities. Prenatal care was defined as adequate or inadequate according to the recommendations of the Brazilian Ministry of Health. The chi-square test and Poisson regression were used to compare differences in the inadequacy of prenatal care utilization. The percentage of inadequacy was higher in São Luís (34.6%) than in Ribeirão Preto (16.9%). Practically the same variables were associated with inadequacy in both cities. Puerperae with lower educational level, without a companion or cohabiting, who delivered in public health units, younger than 20 years, multiparae and smokers, with low family income presented higher percentages of inadequate prenatal care utilization. However, the effects of some variables differed between the two cities. The risk for inadequate use of prenatal care was higher for women attended in the public health sector in São Luís and for cohabiting women in Ribeirão Preto. The effect of the remaining factors studied did not differ between cities. The category of admission accounted for 57.0% of the difference in the inadequate use of prenatal care between cities and marital status accounted for 45.3% of the difference. Even after adjustment for all variables, part of the difference in the inadequacy of prenatal care utilization remained unexplained.

High prevalence of HTLV-1 and 2 viruses in pregnant women in São Luis, state of Maranhão, Brazil.

INTRODUCTION Human T cell lymphotropic virus type 1 (HTLV-1) is endemic in the Caribbean, Japan, South America and regions of Africa. HTLV-2 is present in Native American populations and associated with IV drug use in Europe and North America. In Brazil, it is estimated that 1.5 million people are infected with HTLV-1/2. The study objective was to determine HTLV-1/2 prevalence in pregnant women in the prenatal care from three public services in São Luis, State of Maranhão, Brazil, and to counsel seropositive women to reduce viral transmission. METHODS A cross-sectional study was conducted from February to December 2008; women with age of 18 to 45 years, with low risk for sexually transmitted disease (STD) were invited to participate. Blood samples were collected in filter paper, and HTLV-1/2 immunoenzymatic test (ELISA) was performed as a screening test. Women with reactive results were submitted to peripheral venous blood collection for ELISA repetition, followed by Western blot (WB) and real-time PCR to confirm and discriminate the infection between virus types 1 and 2. RESULTS Of the 2,044 women tested, seven (0.3%) were ELISA reactive and confirmed positive (four were HTLV-1, and three were HTLV-2). All positive women were oriented not to breastfeed their newborns. CONCLUSIONS This study showed that the virus is present in high prevalence in that population. Further studies covering other segments of the population are necessary to better characterize the presence of HTLV-1/2 in Maranhão and to elicit measures to prevent its spread.

Modelando a integralidade do cuidado à criança na Atenção Básica de Saúde

Cuidar da crianca na Atencao Basica de Saude (ABS) na perspectiva da integralidade sugere organizacao e abordagem envolvendo articulacao de saberes e fazeres. Nesse sentido, questiona-se: Que praticas, gestores, formadores e profissionais da saude reconhecem como necessarias para a integralidade do cuidado? O estudo teve como objetivo compreender como sao produzidas as praticas de cuidado a crianca na atencao basica na perspectiva da integralidade em saude. Os pressupostos da abordagem qualitativa e da Grounded Theory guiaram a coleta e analise dos dados aliada a entrevista semi-estruturada. Participaram da investigacao 29 sujeitos organizados em cinco grupos amostrais. Descreve-se uma das categorias construidas na investigacao nomeada “Modelando a Integralidade do Cuidado a Crianca na ABS”. Esse conceito e caracterizado pelo modo de encontro e preparo dos profissionais para uma aproximacao com a familia por meio do trabalho em equipe e praticas intersetoriais, aliando ao saber tecnico as tecnologias relacionais e subjetivas.

Qualidade de vida de mulheres tratadas de câncer de mama em uma cidade do nordeste do Brasil

O objetivo deste estudo foi avaliar a qualidade de vida de mulheres tratadas cirurgicamente de câncer de mama no Hospital de Referencia Estadual em Oncologia de Sao Luis (MA). A qualidade de vida foi avaliada pelo Functional Assessment of Cancer Therapy-Breast (FACT-B). As variaveis foram expressas em media e desvio padrao; e a analise estatistica constou da Anova ou Kruskal Wallis e Teste t de Student ou Mann-Whitney. O nivel de significância foi α < 5%. Na estatistica foram usados o Stata 9.0 e o BioEstat 5.0. Participaram 197 mulheres com idade media de 53,0 ± 11,7 anos. Os valores medios do FACT-B demonstraram tendencia para boa qualidade de vida, sendo o dominio Emocional o mais comprometido e a Subescala Câncer a mais favoravel. O tipo de cirurgia influenciou os dominios Social, Emocional e Subescala câncer do questionario. A cirurgia nao conservadora apresentou piores niveis de qualidade de vida. Viu-se relacao estatistica significante entre o tempo de cirurgia e os dominios Fisico, Emocional e Funcional, bem como entre tempo de cirurgia e os escores do FACT-B. O tratamento adjuvante influenciou todos os dominios do FACT-B. A qualidade de vida encontrada foi relativamente boa, mas influenciada negativamente pela cirurgia nao conservadora, pelo menor tempo desde a cirurgia e pelas terapias adjuvantes.

Cobertura vacinal do esquema básico para o primeiro ano de vida nas capitais do Nordeste brasileiro

O estudo SERVIDIAH (Avaliacao de Servicos de Atencao Basica a Saude para Diabeticos e Hipertensos) foi realizado em 2010 no Estado de Pernambuco, Brasil. Foi constituida uma amostra aleatoria de 785 hipertensos e 823 diabeticos oriunda dos cadastros de 208 equipes da Estrategia Saude da Familia (ESF) sorteadas em 35 municipios do estado. Os usuarios foram entrevistados por meio de formulario padronizado, e tiveram afericao de peso, altura e pressao arterial e, para os diabeticos, da hemoglobina glicada (HbA1c). A idade media foi em torno de 60 anos, com sobrerrepresentacao de mulheres (70%). A pressao arterial foi controlada em 43,7% dos hipertensos e 25,8% dos diabeticos; 30,5% dos diabeticos apresentaram HbA1c abaixo de 7%. Apesar de 70% apresentarem sobrepeso ou obesidade, poucos referiram estar seguindo dieta para perder peso. O estudo, nesta amostra representativa de hipertensos e diabeticos cadastrados na ESF de Pernambuco, mostra que melhorias devem ser buscadas a fim de aprimorar a prevencao das complicacoes desses agravos, cuja incidencia esta crescente.

Traumatic and Non-traumatic Fibromyalgia Syndrome: Impact Assessment on the Life Quality of Women

Objective To investigate the impact on life quality of women with traumatic and non-traumatic origin fibromyalgia syndrome [FMS]. Method Women affected with FMS were selected and divided into two groups: those with traumatic origin FMS [Group 1] and those with non-traumatic origin FMS [Group 2]. A standard question form was used for the research, as well as the fibromyalgia impact questionnaire [FIQ] for evaluation of life quality. Results Seventy-two patients, 34 for Group 1 and 38 for Group 2 were analyzed. The main triggering symptoms were divorce [23.5 percent of cases] and death in the family [23.5 percent of cases]. In addition to diffuse pain, the main symptoms presented were poor sleep quality, weariness, and paresthesia, with no difference between the groups; migraine had a greater prevalence in Group 1 [P = 0.0006]; evaluation of life quality by the FIQ was poorer for Group 1 [P < 0.0001]. Conclusion The impact of FMS on life quality is greater for women suffering from traumatic origin FMS.